Development of a Knowledge-Based Clinical Decision Support System for Community Medicine using PDA

本研究旨在为社区医学开发一个移动的、以知识为基础的临床决策支持系统，并在现场评估该系统的有用性。该系统采用客户端-服务器架构，由以下组件组成。服务器系统：(a)知识生成子系统，从存储在医院信息系统中的医疗数据生成诊断知识。(b)根据生成的知识推断可能的诊断候选者的推理系统。(c)接收来自客户端系统的查询并返回推断结果的服务器应用程序。客户机系统：客户机应用程序，提供输入患者症状和显示推断结果的接口。2004年，我们为岛根大学的软件开发配备了服务器系统，并在其上实现了之前开发的知识生成系统和推理系统。然后，我们开发了一个与客户端系统通信的服务器应用程序，并使用笔记PC和PDA进行了通信实验。在2005年，我们已经在2台笔记本电脑和8台pda上实现了客户端系统。之后，我们在岛根县社区医学网络的一所医院进行了现场交流实验。因此，我们已确认该系统可与个人手提电话系统服务支持领域的笔记本电脑一起使用。然而，我们也面临着以下问题。(1)目前PDA的软件开发环境适合构建用户界面，但不适合构建智能客户端系统。因此，我们必须在PDA上使用Web界面。(2)部分人口稀少地区小灵通服务不足。因此，我们不得不使用其他通信设备。这些结果表明，在当前区域通信环境中，基于pda的移动远程医疗系统的使用存在局限性。

This research aims at developing a mobile, knowledge-based clinical decision support system for community medicine and evaluating the usefulness of the developed system on-site. The system has a client-server architecture and consists of the following components.1.server system : (a)A knowledge generation subsystem that generates diagnostic knowledge from medical data stored on the hospital information systems. (b)An inference system that infers possible candidates of diagnosis based on the generated knowledge. (c)A server application that receives queries from client systems and returns inference results.2.client system : A client application that provides an interface for inputting patient's symptoms and displaying the inference results.In 2004, we have equipped server systems for software development on Shimane University, and implemented the previously developed knowledge generation system and inference systems thereon. We then developed a server application that communicates with client systems, and performed communication experiments with a note PC and a PDA.In 2005, we have implemented the client systems on 2 note PCs and 8 PDAs. After that, we performed an on-site communication experiment in a hospital who is a member of the Shimane network for community medicine.Consequently, we have confirmed that the system can be used with note PCs under the support areas of personal handyphone system services. However, we've also faced the following problems. (1)Current software development environments for PDA are suitable for building the user interface, however, are not sufficient for building intelligent client systems. Therefore, we have to use a Web interface on PDA. (2)In some underpopulated regions, PHS services were not available. Therefore, we had to use other communication devices. These results suggested the limitation of the use of PDA-based mobile telemedicine systems in current regional communication environments.