of The Medical Gopher Order and Note Writing Tool ... context-specific templates within more than 1500 ... (HTML and Java script), but complex form rendering.
An Open-Source XML-Based Java Implementation of The Medical Gopher Order and Note Writing Tool Burke Mamlin, M.D.t, Lonnie Blevins, Jeffry Warvel, Clement J. McDonald, M.D.t Regenstrief Institute for Health Care, Indianapolis, Indiana In our latest attempt, we developed an XML (eXtensible Markup Language) schema that represents our order and note templates, including forms comprised of text and fields with field choices that can themselves contain nested forms. We then created a Java application that converts our knowledgebase from a locally supported format into XML. Using an open-source XML parser and Java's Swing interface, we dynamically generate complex interactive forms based on the XML. The combination of Java, Java's Swing interface and open-source XML parsers allows us to recreate and enhance the order and note entry process. LESSONS LEARNED * DOS offers responsiveness and keyboard control often lost in windowed applications * Browser-based applications suffer from limited keyboard control, slow rendering of complex forms and faults within the browser * Using the Swing interface, Java offers a platform-independent environment that can maintain the keyboard control and quick responses necessary for order and note entry * XML-based medical knowledge can be translated into templates for order entry Acknowledgements: This work is supported in part by Medical Informatics Training Grant ITISLM07117-04 from the National Library of Medicine and by Siemens Medical Solutions Health Services Corporation. REFERENCES 'McDonald CJ, Tierney WM. The Medical Gopher A Microcomputer System to Help Find, Organize and Decide About Patient Data. The Western J. of Med 1986; 145(6):829. 2Nadkami PM, Brandt CM, Marenco L. WebEAV: Automatic Metadata-driven Generation of Web Interfaces to Entity-Attribute-Value Databases. J Am Med Inform Assoc 2000; 7(4):343-356. 3Teich JM. Clinical information systems for integrated healthcare networks. Proceedings / AMIA Annual Symposium 1998;19-28. 4Wang K, van Wingerde FJ, Bradshaw K, Szolovits P, Kohane I. A Java-based multi-institutional medical information retrieval system. Proceedings / AMIA Annual Fall Symposium 1997;538-542.
BACKGROUND The Medical Gopher is an electronic order-entry and note writing system used at Wishard Hospital, a county hospital in Indianapolis, Indiana.' Wishard physicians have entered orders into the system for more than 15 years. Many physicians are entering their ward and clinic notes into this system as well (currently, >3000 notes per week). Even though The Medical Gopher System was created within a DOS environment and continues to run under DOS or within a DOS window, the physicians are very positive about the order entry process. Housestaff rate Wishard's computer system significantly higher than other computer systems on campus, including our VA hospital that uses a windowed order entry system; on a 5-point Likert scale: Wishard (Gopher) 4.20±0.93 with other hospitals 2.27±1.21, 3.30±0.85 and 3.33±0.94 (p < 0.05). At exit interviews, housestaff consistently describe the computer system at Wishard as a major positive in their training experience. We attribute the success of the system to two characteristics. First, the system is blazingly fast. Between-field delays range from 0.1 seconds to unmeasurable. Second, the system is driven by an intelligent knowledge base of over 4000 individual context-specific templates within more than 1500 order items (e.g., Penicillin V oral, CXR PA & Lat) and 400 problem note items. Over the past decade, users have picked a menu item from a structured template in 80% and typed free text in only 20% of cases, confirming that templates and menus are important for order writing at our institution. We have been working to re-express our knowledge base and the Gopher order and note entry in a graphical user interface that is both extensible and lends itself to becoming an open-source resource while maintaining the features that have made the Gopher a success (i.e., responsiveness, and using our existing knowledge base). DESCRIPTION Our first attempt used pure browser technology (HTML and Java script), but complex form rendering and interactive features were too slow to be acceptable. Others have shared this experience.?3'4 Within a browser, we could not control necessary aspects of the user interface (i.e., capture all keystrokes, make modal windows, etc.) and the code was difficult to maintain.
1067-5027/01/$5.00 C 2001 AMIA, Inc.
t Indiana University,
826
Indianapolis, Indiana
