Knowledge Engineering in Health Informatics

This monograph series is intended to provide medical information scien­ tists, health care administrators, physicians, nurses, other health care pro­ viders, and computer science professionals with successful examples and experiences of computer applications in health care settings. Through these computer applications, we attempt to show what is effective and efficient, and hope to provide guidance on the acquisition or design of medical information systems so that costly mistakes can be avoided. Health care provider organizations such as hospitals and clinics are experiencing large demands for clinical information because of a transition from a "fee-for-service" to a "capitation-based" health care economy. This transition changes the way health care services are being paid for. Previ­ ously, nearly all health care services were paid for by insurance companies after the services were performed. Today, many procedures need to be pre approved and many charges for clinical services must be justified to the insurance plans. Ultimately, in a totally capitated system, the more patient care services are provided per patient, the less profitable the health care provider organization will be. Clearly, the financial risks have shifted from the insurance carriers to the health care provider organizations. For hospitals and clinics to assess these financial risks, management needs to know what services are to be provided and how to reduce them without impacting the quality of care. The balancing act of reducing costs but maintaining health care quality and patient satisfaction requires accurate information about the clinical services.

Medical expert systems are designed to help physicians and other healthcare providers give consistent optimal care to every patient. They also allow nonexperts (assisted by computer) to make diagnostic decisions with precision and accuracy approaching that of medical experts. Knowledge Engineering in Health Informatics gives an in-depth guide to the creation of such systems, using Iliad as a model. The book includes the core material for courses such as Medical Knowledge Engineering and Export System Development. Bundled with this book is a CD-ROM produced by Mosby-Year Book that contains an array of knowledge engineering tools featuring: a dictionary program to create hierarchical lists of terms, frame author to create decision frames, utilities to analyze the dictionary and frame content, a compiler to compile frames into a knowledge base, the Iliad 4.5 application, and a text file of the knowledge engineering tools user manual.