Henry J. Lowe, MD

All Publications

• Discretization of Continuous Features in Clinical Datasets J. AM Inform Assoc (In Press). Maslove DM, Podchiyska T, Lowe HJ 2012
• Genomics in the clinic: ethical and policy challenges in clinical next-generation sequencing programs at early adopter USA institutions PERSONALIZED MEDICINE Milner, L. C., Garrison, N. A., Cho, M. K., Altman, R. B., Hudgins, L., Galli, S. J., Lowe, H. J., Schrijver, I., Magnus, D. C. 2015; 12 (3): 269-282

  View details for DOI 10.2217/PME.14.88

  View details for Web of Science ID 000355751600011

• Transdisciplinary translational science and the case of preterm birth JOURNAL OF PERINATOLOGY Stevenson, D. K., Shaw, G. M., Wise, P. H., Norton, M. E., Druzin, M. L., Valantine, H. A., McFarland, D. A. 2013; 33 (4): 251-258

  Abstract

  Medical researchers have called for new forms of translational science that can solve complex medical problems. Mainstream science has made complementary calls for heterogeneous teams of collaborators who conduct transdisciplinary research so as to solve complex social problems. Is transdisciplinary translational science what the medical community needs? What challenges must the medical community overcome to successfully implement this new form of translational science? This article makes several contributions. First, it clarifies the concept of transdisciplinary research and distinguishes it from other forms of collaboration. Second, it presents an example of a complex medical problem and a concrete effort to solve it through transdisciplinary collaboration: for example, the problem of preterm birth and the March of Dimes effort to form a transdisciplinary research center that synthesizes knowledge on it. The presentation of this example grounds discussion on new medical research models and reveals potential means by which they can be judged and evaluated. Third, this article identifies the challenges to forming transdisciplines and the practices that overcome them. Departments, universities and disciplines tend to form intellectual silos and adopt reductionist approaches. Forming a more integrated (or 'constructionist'), problem-based science reflective of transdisciplinary research requires the adoption of novel practices to overcome these obstacles.

  View details for DOI 10.1038/jp.2012.133

  View details for PubMedID 23079774

• A Simple Heuristic for Blindfolded Record Linkage J AM Med Inform Assoc Weber SC, Lowe HJ, Seto T, Olson G, Ferris T, Das AK, Kurian A, Olson C, Pragati K 2012; 19 (e1): e157-e161
• Computerized physician order entry in the critical care environment: a review of current literature. Journal of intensive care medicine Maslove, D. M., Rizk, N., Lowe, H. J. 2011; 26 (3): 165-171

  Abstract

  The implementation of health information technology (HIT) is accelerating, driven in part by a growing interest in computerized physician order entry (CPOE) as a tool for improving the quality and safety of patient care. Computerized physician order entry could have a substantial impact on patients in intensive care, where the potential for medical error is high, and the clinical workflow is complex. In 2009, only 17% of hospitals had functional CPOE systems in place. In intensive care unit (ICU) settings, CPOE has been shown to reduce the occurrence of some medication errors, but evidence of a beneficial effect on clinical outcomes remains limited. In some cases, new error types have arisen with the use of CPOE. Intensive care unit workflow and staff relationships have been affected by CPOE, often in unanticipated ways. The design of CPOE software has a strong impact on user acceptance. Intensive care unit-specific order sets lessen the cognitive workload associated with the use of CPOE and improve user acceptance. The diffusion of new technological innovations in the ICU can have unintended consequences, including changes in workflow, staff roles, and patient outcomes. When implementing CPOE in critical care areas, both organizational and technical factors should be considered. Further research is needed to inform the design and management of CPOE systems in the ICU and to better assess their impact on clinical end points, cost-effectiveness, and user satisfaction.

  View details for DOI 10.1177/0885066610387984

  View details for PubMedID 21257633

• Managing Medical Vocabulary Updates in a Clinical Data Warehouse: An RxNorm Case Study. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Podchiyska, T., Hernandez, P., Ferris, T., Weber, S., Lowe, H. J. 2010; 2010: 477-481

  Abstract

  Use of terminology standards facilitates aggregating data from multiple sources for information retrieval, exchange and analysis. However, medical vocabularies are continuously updated and incorporating those changes consistently into clinical data warehouses requires rigorous methodology. To integrate pharmacy data from two hospital pharmacy information systems the Stanford Translational Research Integrated Database Environment (STRIDE) project mapped medication orders to RxNorm content using the RxNorm drug model. In order to keep the data relevant and up-to-date, we developed a strategy for updating to RxNorm, while preserving the original meaning and mapping of the legacy data. This case study discusses managing the vocabulary update by following the RxNorm content maintenance strategy and supplementing it with operations to retain access to its drug model information.

  View details for PubMedID 21347024

• Implementing a Real-time Complex Event Stream Processing System to Help Identify Potential Participants in Clinical and Translational Research Studies AMIA Annu Symp Proc Weber SC, Lowe HJ, Malunjkar S, Quinn J 2010: 472-476
• Automated mapping of pharmacy orders from two electronic health record systems to RxNorm within the STRIDE clinical data warehouse. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Hernandez, P., Podchiyska, T., Weber, S., Ferris, T., Lowe, H. 2009; 2009: 244-248

  Abstract

  The Stanford Translational Research Integrated Database Environment (STRIDE) clinical data warehouse integrates medication information from two Stanford hospitals that use different drug representation systems. To merge this pharmacy data into a single, standards-based model supporting research we developed an algorithm to map HL7 pharmacy orders to RxNorm concepts. A formal evaluation of this algorithm on 1.5 million pharmacy orders showed that the system could accurately assign pharmacy orders in over 96% of cases. This paper describes the algorithm and discusses some of the causes of failures in mapping to RxNorm.

  View details for PubMedID 20351858

• STRIDE--An integrated standards-based translational research informatics platform. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Lowe, H. J., Ferris, T. A., Hernandez, P. M., Weber, S. C. 2009; 2009: 391-395

  Abstract

  STRIDE (Stanford Translational Research Integrated Database Environment) is a research and development project at Stanford University to create a standards-based informatics platform supporting clinical and translational research. STRIDE consists of three integrated components: a clinical data warehouse, based on the HL7 Reference Information Model (RIM), containing clinical information on over 1.3 million pediatric and adult patients cared for at Stanford University Medical Center since 1995; an application development framework for building research data management applications on the STRIDE platform and a biospecimen data management system. STRIDE's semantic model uses standardized terminologies, such as SNOMED, RxNorm, ICD and CPT, to represent important biomedical concepts and their relationships. The system is in daily use at Stanford and is an important component of Stanford University's CTSA (Clinical and Translational Science Award) Informatics Program.

  View details for PubMedID 20351886

• Using a statistical natural language Parser augmented with the UMLS specialist lexicon to assign SNOMED CT codes to anatomic sites and pathologic diagnoses in full text pathology reports. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Lowe, H. J., Huang, Y., Regula, D. P. 2009; 2009: 386-390

  Abstract

  To address the problem of extracting structured information from pathology reports for research purposes in the STRIDE Clinical Data Warehouse, we adapted the ChartIndex Medical Language Processing system to automatically identify and map anatomic and diagnostic noun phrases found in full-text pathology reports to SNOMED CT concept descriptors. An evaluation of the system's performance showed a positive predictive value for anatomic concepts of 92.3% and positive predictive value for diagnostic concepts of 84.4%. The experiment also suggested strategies for improving ChartIndex's performance coding pathology reports.

  View details for PubMedID 20351885

• Novel integration of hospital electronic medical records and gene expression measurements to identify genetic markers of maturation. Pacific Symposium on Biocomputing. Pacific Symposium on Biocomputing Chen, D. P., Weber, S. C., Constantinou, P. S., Ferris, T. A., Lowe, H. J., Butte, A. J. 2008: 243-254

  Abstract

  Traditionally, the elucidation of genes involved in maturation and aging has been studied in a temporal fashion by examining gene expression at different time points in an organism's life as well as by knocking out, knocking in, and mutating genes thought to be involved. Here, we propose an in silico method to combine clinical electronic medical record (EMR) data and gene expression measurements in the context of disease to identify genes that may be involved in the process of human maturation and aging. First we show that absolute lymphocyte count may serve as a biomarker for maturation by using statistical methods to compare trends among different clinical laboratory tests in response to an increase in age. We then propose using the rate of decay for absolute lymphocyte count across 12 diseases as a proxy for differences in aging. We correlate the differing rates with gene expression across the same diseases to find maturation/aging related genes. Among the 53 genes with strongest correlations between expression profile and change in rate of decay, we found genes previously implicated in the process of aging, including MGMT (DNA repair), TERF2 (telomere stability), POLD1 (DNA replication and repair), and POLG (mtDNA replication).

  View details for PubMedID 18229690

• A novel hybrid approach to automated negation detection in clinical radiology reports JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Huang, Y., Lowe, H. J. 2007; 14 (3): 304-311

  Abstract

  Negation is common in clinical documents and is an important source of poor precision in automated indexing systems. Previous research has shown that negated terms may be difficult to identify if the words implying negations (negation signals) are more than a few words away from them. We describe a novel hybrid approach, combining regular expression matching with grammatical parsing, to address the above limitation in automatically detecting negations in clinical radiology reports.Negations are classified based upon the syntactical categories of negation signals, and negation patterns, using regular expression matching. Negated terms are then located in parse trees using corresponding negation grammar.A classification of negations and their corresponding syntactical and lexical patterns were developed through manual inspection of 30 radiology reports and validated on a set of 470 radiology reports. Another 120 radiology reports were randomly selected as the test set on which a modified Delphi design was used by four physicians to construct the gold standard.In the test set of 120 reports, there were a total of 2,976 noun phrases, of which 287 were correctly identified as negated (true positives), along with 23 undetected true negations (false negatives) and 4 mistaken negations (false positives). The hybrid approach identified negated phrases with sensitivity of 92.6% (95% CI 90.9-93.4%), positive predictive value of 98.6% (95% CI 96.9-99.4%), and specificity of 99.87% (95% CI 99.7-99.9%).This novel hybrid approach can accurately locate negated concepts in clinical radiology reports not only when in close proximity to, but also at a distance from, negation signals.

  View details for DOI 10.1197/jamia.M2284

  View details for Web of Science ID 000246670800007

  View details for PubMedID 17329723

  View details for PubMedCentralID PMC2244882

• Clinical arrays of laboratory measures, or "clinarrays", built from an electronic health record enable disease subtyping by severity. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Chen, D. P., Weber, S. C., Constantinou, P. S., Ferris, T. A., Lowe, H. J., Butte, A. J. 2007: 115-119

  Abstract

  The severity of diseases has often been assigned by direct observation of a patient and by pathological examination after symptoms have appeared. As we move into the genomic era, the ability to predict disease severity prior to manifestation has improved dramatically due to genomic sequencing and analysis of gene expression microarrays. However, as the severity of diseases can be exacerbated by non genetic factors, the ability to predict disease severity by examining gene expression alone may be inadequate. We propose the creation of a "clinarray" to examine phenotypic expression in the form of clinical laboratory measurements. We demonstrate that the clinarray can be used to distinguish between the severities of patients with cystic fibrosis and those with Crohn's disease by applying unsupervised clustering methods that have been previously applied to microarrays.

  View details for PubMedID 18693809

• Improved identification of noun phrases in clinical radiology reports using a high-performance statistical natural language parser augmented with the UMLS Specialist Lexicon JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Huang, Y., Lowe, H. J., Klein, D., Cucina, R. J. 2005; 12 (3): 275-285

  Abstract

  The aim of this study was to develop and evaluate a method of extracting noun phrases with full phrase structures from a set of clinical radiology reports using natural language processing (NLP) and to investigate the effects of using the UMLS(R) Specialist Lexicon to improve noun phrase identification within clinical radiology documents.The noun phrase identification (NPI) module is composed of a sentence boundary detector, a statistical natural language parser trained on a nonmedical domain, and a noun phrase (NP) tagger. The NPI module processed a set of 100 XML-represented clinical radiology reports in Health Level 7 (HL7)(R) Clinical Document Architecture (CDA)-compatible format. Computed output was compared with manual markups made by four physicians and one author for maximal (longest) NP and those made by one author for base (simple) NP, respectively. An extended lexicon of biomedical terms was created from the UMLS Specialist Lexicon and used to improve NPI performance.The test set was 50 randomly selected reports. The sentence boundary detector achieved 99.0% precision and 98.6% recall. The overall maximal NPI precision and recall were 78.9% and 81.5% before using the UMLS Specialist Lexicon and 82.1% and 84.6% after. The overall base NPI precision and recall were 88.2% and 86.8% before using the UMLS Specialist Lexicon and 93.1% and 92.6% after, reducing false-positives by 31.1% and false-negatives by 34.3%.The sentence boundary detector performs excellently. After the adaptation using the UMLS Specialist Lexicon, the statistical parser's NPI performance on radiology reports increased to levels comparable to the parser's native performance in its newswire training domain and to that reported by other researchers in the general nonmedical domain.

  View details for DOI 10.1197/jamia.M1695

  View details for Web of Science ID 000229384600005

  View details for PubMedID 15684131

  View details for PubMedCentralID PMC1090458

• A pilot study of contextual UMLS indexing to improve the precision of concept-based representation in XML-structured clinical radiology reports JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Huang, Y., Lowe, H. J., Hersh, W. R. 2003; 10 (6): 580-587

  Abstract

  Despite the advantages of structured data entry, much of the patient record is still stored as unstructured or semistructured narrative text. The issue of representing clinical document content remains problematic. The authors' prior work using an automated UMLS document indexing system has been encouraging but has been affected by the generally low indexing precision of such systems. In an effort to improve precision, the authors have developed a context-sensitive document indexing model to calculate the optimal subset of UMLS source vocabularies used to index each document section. This pilot study was performed to evaluate the utility of this indexing approach on a set of clinical radiology reports.A set of clinical radiology reports that had been indexed manually using UMLS concept descriptors was indexed automatically by the SAPHIRE indexing engine. Using the data generated by this process the authors developed a system that simulated indexing, at the document section level, of the same document set using many permutations of a subset of the UMLS constituent vocabularies.The precision and recall scores generated by simulated indexing for each permutation of two or three UMLS constituent vocabularies were determined.While there was considerable variation in precision and recall values across the different subtypes of radiology reports, the overall effect of this indexing strategy using the best combination of two or three UMLS constituent vocabularies was an improvement in precision without significant impact of recall.In this pilot study a contextual indexing strategy improved overall precision in a set of clinical radiology reports.

  View details for DOI 10.1197/jamia.M1369

  View details for PubMedID 12925544

• Preparing doctors for bedside computing. Lancet Moffett, S. E., Menon, A. S., Meites, E. M., Kush, S., Lin, E. Y., Grappone, T., Lowe, H. L. 2003; 362 (9377): 86-?

  View details for PubMedID 12853225

• A randomized trial using computerized decision support to improve treatment of major depression in primary care 13th NIMH International Conference on Mental Health Problems in the General Health Care Sector Rollman, B. L., Hanusa, B. H., Lowe, H. J., Gilbert, T., Kapoor, W. N., Schulberg, H. C. SPRINGER. 2002: 493–503

  Abstract

  To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.Randomized controlled trial.Academically affiliated primary care practice in Pittsburgh, PA.Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria.PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: "active care" (AC), "passive care" (PC), or "usual care" (UC).Patients' 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D /=3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P =.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P =.3).Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.

  View details for Web of Science ID 000176923700001

  View details for PubMedID 12133139

• A proposed key escrow system for secure patient information disclosure in biomedical research databases Annual Symposium of the American-Medical-Informatics-Association Ferris, T. A., Garrison, G. M., Lowe, H. J. HANLEY & BELFUS INC MED PUBLISHERS. 2002: 245–249

  Abstract

  Access to clinical data is of increasing importance to biomedical research. The pending HIPAA privacy regulations provide specific requirements for the release of protected health information. Under the regulations, biomedical researchers may utilize anonymized data, or adhere to HIPAA requirements regarding protected health information. In order to provide researchers with anonymized data from a clinical research database, we reviewed several published strategies for de-identification of protected health information. Critical analysis with respect to this project suggests that de-identification alone is problematic when applied to clinical research databases. We propose a hybrid system; utilizing secure key escrow, de-identification, and role-based access for IRB approved researchers.

  View details for PubMedID 12463824

• The electronic medical record 13th NIMH International Conference on Mental Health Problems in the General Health Care Sector Rollman, B. L., Hanusa, B. H., Gilbert, T., Lowe, H. J., Kapoor, W. N., Schulberg, H. C. AMER MEDICAL ASSOC. 2001: 189–97

  Abstract

  Inadequate treatments are reported for depressed patients cared for by primary care physicians (PCPs). Providing feedback and evidence-based treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions.Patients presenting to an urban academically affiliated primary care practice were screened for major depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD). During 20-month period, 212 patients met protocol-eligibility criteria and completed a baseline interview. They were cared for by 16 board-certified internists, who were electronically informed of their patients' diagnoses, and randomized to 1 of 3 methods of exposure to guideline-based advice for treating depression (active, passive, and usual care). Ensuing treatment patterns were assessed by medical chart review and by patient self-report at baseline and 3 months.Median time for PCP response to the electronic message regarding the patient's depression diagnosis was 1 day (range, 1-95 days). Three days after notification, 120 (65%) of 186 PCP responses indicated agreement with the diagnosis, 24 (13%) indicated disagreement, and 42 (23%) indicated uncertainty. Primary care physicians who agreed with the diagnoses sooner were more likely to make a medical chart notation of depression, begin antidepressant medication therapy, or refer to a mental health specialist (P<.001). There were no differences in the agreement rate or treatments provided across guideline exposure conditions.Electronic feedback of the diagnosis of major depression can affect PCP initial management of the disorder. Further study is necessary to determine whether this strategy, combined with delivery of treatment recommendations, can improve clinical outcomes in routine practice.

  View details for Web of Science ID 000166480500007

  View details for PubMedID 11176732

• Evaluation of a filmless radiology pilot - A preliminary report Annual Symposium of the American-Medical-Informatics-Association (AMIA 2001) Mast, C. G., Caruso, M. A., Gadd, C. S., Lowe, H. J. BMJ PUBLISHING GROUP. 2001: 443–447

  Abstract

  The development of the Multimedia Electronic Medical Record System (MEMRS) promises new opportunities to significantly reduce the routine use of film as the medium for viewing radiological medical images. The effect of this change to digital media on physician workflow and the perceived value and utility of medical images is an area of ongoing investigation. In this study we examined oncology clinicians use of medical images in a MEMRS. We conducted observational studies of clinicians during a filmless radiology pilot study in which a filmless environment was simulated but the actual film was available on request. This observational study was the first step in a comprehensive evaluation designed to elucidate the issues surrounding the implementation of a filmless radiology environment. We identified and examined several of these issues, including physician concern regarding the utility of digital images for clinical use and comparison with film, the need to address the effects of image compression with clinicians, and the workflow changes necessary to incorporate digital image use into a clinical practice.

  View details for Web of Science ID 000172263400091

  View details for PubMedID 11825227

• Selective automated indexing of findings and diagnoses in radiology reports. J Biomed Inform Hersh W, Mailhot M, Arnott-Smith C, Lowe H 2001; 34 (4): 262-273
• Defining the role of anatomic pathology images in the multimedia electronic medical record - A preliminary report Annual Symposium of the American-Medical-Informatics-Association Crowley, R. S., Gadd, C. S., Naus, G., Becich, M., Lowe, H. J. HANLEY & BELFUS INC. 2000: 161–165

  Abstract

  The development of the Multimedia Electronic Medical Record System (MEMRS) offers new opportunities for integrating medical imaging data with text-based clinical data. The effective integration of pathology images into the patient's medical record poses some significant technical and organizational challenges. Before these challenges can be met, it is imperative that we investigate the value and utility of providing these images to clinicians. In this study we examined attitudes towards use of pathology images in Image Engine, a MEMRS under development at the University of Pittsburgh Cancer Institute (UPCI). We conducted semi-structured standardized interviews with a cohort of practicing oncologists, all of whom had significant experience with Image Engine. This study is a first step towards elucidating the potential barriers, uses, and value of anatomic pathology images in the MEMRS.

  View details for Web of Science ID 000170207500034

  View details for PubMedID 11079865

• Automated semantic indexing of imaging reports to support retrieval of medical images in the multimedia electronic medical record 1st International Working Conference on Electronic Patient Records in Medical Practice (EPRiMP) Lowe, H. J., Antipov, I., Hersh, W., Smith, C. A., Mailhot, M. SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN. 1999: 303–7

  Abstract

  This paper describes preliminary work evaluating automated semantic indexing of radiology imaging reports to represent images stored in the Image Engine multimedia medical record system at the University of Pittsburgh Medical Center. The authors used the SAPHIRE indexing system to automatically identify important biomedical concepts within radiology reports and represent these concepts with terms from the 1998 edition of the U.S. National Library of Medicine's Unified Medical Language System (UMLS) Metathesaurus. This automated UMLS indexing was then compared with manual UMLS indexing of the same reports. Human indexing identified appropriate UMLS Metathesaurus descriptors for 81% of the important biomedical concepts contained in the report set. SAPHIRE automatically identified UMLS Metathesaurus descriptors for 64% of the important biomedical concepts contained in the report set. The overall conclusions of this pilot study were that the UMLS metathesaurus provided adequate coverage of the majority of the important concepts contained within the radiology report test set and that SAPHIRE could automatically identify and translate almost two thirds of these concepts into appropriate UMLS descriptors. Further work is required to improve both the recall and precision of this automated concept extraction process.

  View details for Web of Science ID 000084637800013

  View details for PubMedID 10805018

• Transforming the cancer center in the 21st century. M.D. computing : computers in medical practice Lowe, H. J. 1999; 16 (3): 40-42

  Abstract

  Academic cancer centers will be hit, simultaneously, by all three of the technology tidal waves outlined above within the next five years. In preparing for this impact one should note the central role that Internet technologies will play in providing solutions in all three areas. In addition, as the volume and size of data objects increases dramatically, having an adequate networking infrastructure in place will be crucial. So what do we do now to prepare for the future? The following five steps are suggested: (1) Establish an oncology informatics group within the cancer center to provide the necessary expertise and begin the planning process. (2) Begin implementing a secure intranet based on standard Internet technologies. (3) Work with the host medical center and external agencies to determine who will pay for and implement a high-bandwidth networking infrastructure. (4) Recruit a bioinformatician who can help implement technologies to take advantage of the genomics data wave when it hits. (5) Ensure that the cancer center's EMR system can support cancer protocol data and facilitate the retrieval and delivery of the complex digital imaging data that are in our future.

  View details for PubMedID 10439599

• Multimedia electronic medical record systems ACADEMIC MEDICINE Lowe, H. J. 1999; 74 (2): 146-152

  Abstract

  A wide range of imaging technologies are becoming increasingly important to the practice of medicine. In addition, many medical specialties are highly visual, independent of their use of new imaging modalities. Because today's medical record contains text, images, and physiologic signals, it is inherently multimedia in nature. However, most electronic medical record systems handle only the textual portion of the patient record, resulting in a fragmentation of the database that physicians need to make timely, effective clinical decisions. Advances in database-, storage-, data-compression, and networking technologies will facilitate the development of multimedia electronic medical record systems for the 21st century. These systems will become widely used over the next decade, and in addition to enhancing patient care, will also present new opportunities for using clinical imaging data for biomedical research and education.

  View details for Web of Science ID 000078705800016

  View details for PubMedID 10065056

• The electronic medical record: Its role in disseminating depression guidelines in primary care practice INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE Rollman, B. L., Gilbert, T., Lowe, H. J., Kapoor, W. N., Schulberg, H. C. 1999; 29 (3): 267-286

  Abstract

  Using the Agency for Health Care Policy and Research Depression Guideline Panel's recommendations as its focus, this article describes a step-by-step approach for disseminating a paper-based depression guideline to primary care physicians via a commercially available electronic medical record (EMR) system.Description of the author's approach to disseminate an evidence-based depression treatment guideline to a group of primary care physicians using a commercially available EMR system and to evaluate the results.We review clinical considerations and practical barriers faced in this process with the expectation that our experiences can guide others attempting to disseminate psychiatric treatment guideline via EMR systems.The EMR offers critical efficiencies in disseminating state-of-the-art clinical practice guidelines and in directing the primary care physicians' use of them. Still, well-designed, randomized controlled trials are necessary to demonstrate their effectiveness at enhancing patient outcomes for major depression in primary care settings.

  View details for Web of Science ID 000084640400002

  View details for PubMedID 10642902

• Information needs research in the era of the digital medical library JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Lomax, E. C., Lowe, H. J. 1998: 658-662

  Abstract

  The rapid adoption of Internet-accessible information resources by the clinical community, has resulted in an exponential growth in the variety and type of clinical information resources along with an increasing diversity of information technologies to deliver clinical information. To date, little formal work has been done to investigate the significance of new information technologies such as Internet-based digital libraries and multimedia record systems on clinical information need or information seeking behavior. In the work described in this paper, we highlight some results from our recent multimethod research design and investigation of the information-seeking behavior of Pittsburgh area medical oncologists to argue for the use of a multimethod research design as an essential component of any investigation of clinical information need and information-seeking behavior in the era of the digital medical library.

  View details for Web of Science ID 000171768600128

  View details for PubMedID 9929301

• Towards knowledge-based retrieval of medical images. The role of semantic indexing, image content representation and knowledge-based retrieval. JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Lowe, H. J., Antipov, I., Hersh, W., Smith, C. A. 1998: 882-886

  Abstract

  Medicine is increasingly image-intensive. The central importance of imaging technologies such as computerized tomography and magnetic resonance imaging in clinical decision making, combined with the trend to store many "traditional" clinical images such as conventional radiographs, microscopic pathology and dermatology images in digital format present both challenges and an opportunities for the designers of clinical information systems. The emergence of Multimedia Electronic Medical Record Systems (MEMRS), architectures that integrate medical images with text-based clinical data, will further hasten this trend. The development of these systems, storing a large and diverse set of medical images, suggests that in the future MEMRS will become important digital libraries supporting patient care, research and education. The representation and retrieval of clinical images within these systems is problematic as conventional database architectures and information retrieval models have, until recently, focused largely on text-based data. Medical imaging data differs in many ways from text-based medical data but perhaps the most important difference is that the information contained within imaging data is fundamentally knowledge-based. New representational and retrieval models for clinical images will be required to address this issue. Within the Image Engine multimedia medical record system project at the University of Pittsburgh we are evolving an approach to representation and retrieval of medical images which combines semantic indexing using the UMLS Metathesuarus, image content-based representation and knowledge-based image analysis.

  View details for Web of Science ID 000171768600172

  View details for PubMedID 9929345

• The Image Engine(TM) HPCC project. A medical digital library system using agent-based technology to create an integrated view of the electronic medical record 3rd Forum on Research and Technology Advances in Digital Libraries (ADL 96) Lowe, H. J., Walker, W. K., Polonkey, S. E., Jiang, F. C., VRIES, J. K., McCray, A. I E E E, COMPUTER SOC PRESS. 1996: 45–56

  View details for Web of Science ID A1996BF68X00005

• WebReport: a World Wide Web based clinical multimedia reporting system. Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium Lowe, H. J., Antipov, I., Walker, W. K., Polonkey, S. E., Naus, G. J. 1996: 314-318

  Abstract

  This paper describes WebReport, a World Wide Web (WWW) client for the Image Engine multimedia clinical information system under development at the University of Pittsburgh. WebReport uses advanced HTML features such as frames, forms, tables and inline JPEG image display to provide an easy to use system for retrieving and viewing diagnostic images and reports generated by clinical procedures such as gastrointestinal endoscopy, radiology and surgical pathology. WebReport implements a number of WWW client-side features, such as HTML forms data entry verification and makes extensive use of the JavaScript programming language. The WebReport system uses a number of approaches for ensuring the confidentiality and security of patient data transmitted over the InterNet.

  View details for PubMedID 8947679

• The World Wide Web: A review of an emerging Internet-based technology for the distribution of biomedical information JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION Lowe, H. J., Lomax, E. C., Polonkey, S. E. 1996; 3 (1): 1-14

  Abstract

  The Internet is rapidly evolving from a resource used primarily by the research community to a true global information network offering a wide range of databases and services. This evolution presents many opportunities for improved access to biomedical information, but Internet-based resources have often been difficult for the non-expert to develop and use. The World Wide Web (WWW) supports an inexpensive, easy-to-use, cross-platform, graphic interface to the Internet that may radically alter the way we retrieve and disseminate medical data. This paper summarizes the Internet and hypertext origins of the WWW, reviews WWW-specific technologies, and describes current and future applications of this technology in medicine and medical informatics. The paper also includes an appendix of useful biomedical WWW servers.

  View details for Web of Science ID A1996TN79200001

  View details for PubMedID 8750386

• BUILDING A MEDICAL MULTIMEDIA DATABASE SYSTEM TO INTEGRATE CLINICAL INFORMATION - AN APPLICATION OF HIGH-PERFORMANCE COMPUTING AND COMMUNICATIONS TECHNOLOGY Conference on Building the National Health Information Infrastructure - The Role of High Performance Computing and Communications Lowe, H. J., Buchanan, B. G., Cooper, G. F., VRIES, J. K. MEDICAL LIBRARY ASSOC. 1995: 57–64

  Abstract

  The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.

  View details for Web of Science ID A1995QC12200011

  View details for PubMedID 7703940

• Image Engine an Integrated Multimedia Clinical Information System MEDINFO Lowe HJ, Buchanan BG, Cooper GF, Kaplan B, Vries JK 1995; 8 (1): 421-5
• Using agent-based technology to create a cost effective, integrated, multimedia view of the electronic medical record. Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care Lowe, H. J., Walker, W. K., VRIES, J. K. 1995: 441-444

  Abstract

  Image Engine is multi-user, client-server database for the storage, retrieval and sharing of a wide range of digitized biomedical images under development at the University of Pittsburgh. This paper provides an overview of the system and describes the use of agent-based technology to integrate clinical information from the Image Engine database and the MARS clinical information system at the University of Pittsburgh Medical Center. Agent-mediated links provide a mechanism for combining clinical data from multiple databases to create a unified, multimedia view of the electronic medical record.

  View details for PubMedID 8563320

• UNDERSTANDING AND USING THE MEDICAL SUBJECT-HEADINGS (MESH) VOCABULARY TO PERFORM LITERATURE SEARCHES JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Lowe, H. J., Barnett, G. O. 1994; 271 (14): 1103-1108

  Abstract

  The United States National Library of Medicine's (NLM) MEDLINE database is the largest and most widely used medical bibliographic database. MEDLINE is manually indexed with NLM's Medical Subject Headings (MeSH) vocabulary. Using MeSH, a searcher can potentially create powerful and unambiguous MEDLINE queries. This article reviews the structure and use of MeSH, directed toward the nonexpert, and outlines how MeSH may help resolve a number of common difficulties encountered when searching MEDLINE. The increasing importance of the MEDLINE database as an information resource and the trend toward individuals performing their own bibliographic searches makes it crucial that health care professionals become familiar with MeSH.

  View details for Web of Science ID A1994NE22800033

  View details for PubMedID 8151853

• Image Engine: an object-oriented multimedia database for storing, retrieving and sharing medical images and text. Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care Lowe, H. J. 1993: 839-843

  Abstract

  This paper describes Image Engine, an object-oriented, microcomputer-based, multimedia database designed to facilitate the storage and retrieval of digitized biomedical still images, video, and text using inexpensive desktop computers. The current prototype runs on Apple Macintosh computers and allows network database access via peer to peer file sharing protocols. Image Engine supports both free text and controlled vocabulary indexing of multimedia objects. The latter is implemented using the TView thesaurus model developed by the author. The current prototype of Image Engine uses the National Library of Medicine's Medical Subject Headings (MeSH) vocabulary (with UMLS Meta-1 extensions) as its indexing thesaurus.

  View details for PubMedID 8130596

• Evaluation of a microcomputer system for searching the MEDLINE Database Proc Annu Symp Comput Appl Med Care Lowe HJ, Barnett GO 1989: 445-447
• Mapping to MeSH - The art of trapping MeSH Equivalence from within narrative text Proc Annu Symp Comput Appl Med Care Elkin PL, Cimino JJ, Lowe HJ 1988: 185-190
• Remote Access MicroMeSH: A Microcomputer System for Searching MEDLINE Proc Annu Symp Comput Appl Med Care Lowe HJ, Barnett GO 1988: 535-539
• MicroMeSH: A Microcomputer System for Searching and Exploring the National Library Medicine's Medical Subject Headings (MeSH) Vocabulary Proc Annu Symp Comput Appl Med Care Lowe HJ, Barnett GO 1987: 717-720
• DXPLAIN: A Computer-Based Diagnostic Knowledge Base MEDINFO Hupp JA, Cimino JJ, Hoffer EP, Lowe HJ 1986; 8 (1): 421-5
• Remote Access MicroMeSH: An Enhanced Microcomputer System for Searching the MEDLINE Database Proc Annu Symp Comput Appl Med Care Lowe HJ, Barnett GO, Scott J 1986: 1009-1011