Mental Health Computing

500 Pages·1996·8.829 MB·English

by  Marvin J. Miller M.D., Kenric W. Hammond M.D., Matthew G. Hile Ph.D. (auth.)

Computers and Medicine
Helmuth F. Orthner, Series Editor
Springer
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Computers and Medicine
Information Systems for Patient Care
Bruce I. Blum (Editor)
Computer-Assisted Medical Decision Making, Volume 1
James A. Reggia and Stanley Tuhrim (Editors)
Computer-Assisted Medical Decision Making, Volume 2
James A. Reggia and Stanley Tuhrim (Editors)
Expert Critiquing Systems
Perry L. Miller
Use and Impact of Computers in Clinical Medicine
James G. Anderson and Stephen J. Jay (Editors)
Selected Topics in Medical Artificial Intelligence
Perry L. Miller (Editor)
Implementing Health Care Information Systems
Helmuth F. Orthner and Bruce I. Blum (Editors)
Nursing and Computer~: An Anthology
Virginia K. Saba, Karen A. Rieder, and Dorothy B. Pocklington (Editors)
A Clinical Information System for Oncology
John P. Enterline, Raymond E. Lendhard, Jr., and Bruce I. Blum (Editors)
HELP: A Dynamic Hospital Information System
Gilad J. Kuperman, Reed M. Gardner, and T. Allan Pryor
Decision Support Systems in Critical Care
M. Michael Shabot and Reed M. Gardner (Editors)
Information Retrieval: A Health Care Perspective
William R. Hersh
Mental Health Computing
Marvin J. Miller, Kenric W. Hammond, and Matthew G. Hile
Marvin J. Miller, M.D.
Department of Psychiatry, Larue Carter Hospital, Indianapolis, IN, USA
Kenric W. Hammond, M.D.
Department of Psychiatry, Veterans Administration Medical Center, Tacoma,
WA, USA
Matthew G. Hile, Ph.D.
Missouri Institute of Mental Health, University of Missouri-Columbia, St. Louis,
MO, USA
Mental Health Computing
With 48 Illustrations
i
Springer
Marvin J. Miller Kenric W. Hammond
Department of Psychiatry Department of Psychiatry
Indiana University School of Medicine Veterans Administration
Larue Carter Hospital Medical Center
Indianapolis, IN 46202, USA Tacoma, WA 98493, USA
Matthew G. Hile
Missouri Institute of Mental Health
University of Missouri-Columbia
St. Louis, MO 63139, USA
Series Editor
Helmut F. Orthner
Professor of Computer Medicine
The George Washington University Medical Center
Washington, DC 20037, USA
Library of Congress Cataloging-in-Publication Data
Mental health computing/edited by Marvin J. Miller, Kenric W.
Hammond, Mathew G. Hile.
p. cm. - (Computers and medicine)
Includes bibliographical references and index.
ISBN-13: 978-1-4612-7512-1 (hc: alk. paper)
1. Psychiatry-Data processing. 2. Mental health services-Data
processing. I. Miller, Marvin J., 1946- . II. Hammond, Kenric
W. III. Hile, Matthew G. IV. Series: Computers and medicine (New
York, N.Y.)
RC455.2.D38M45 1996
616.89'OO285-dc20 95-37689
Printed on acid-free paper.
ISBN-13: 978-1-4612-7512-1 e-ISBN-13: 978-1-4612-2352-8
DOl: 10.1007/978-1-4612-2352-8
© 1996 Springer-Verlag New York, Inc.
Softcover reprint of the hardcover 1s t edition 1996
All rights reserved. This work may not be translated or copied in whole or in part without the
written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New
York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly
analysis. Use in connection with any form of information storage and retrieval, electronic
adaptation, computer software, or by similar or dissimilar methodology now known or
hereafter developed is forbidden.
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if the former are not especially identified, is not to be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely
by anyone.
While the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibility for any errors or omissions that may be made. The publisher makes no
warranty, express or implied, with respect to the material contained herein.
Production managed by Chernow Editorial Services, Inc., and supervised by Karen Phillips;
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Typeset by Best-set Typesetter Ltd., Hong Kong.
9 8 7 6 5 432 1
ISBN-13: 978-1-4612-7512-1 Springer-Verlag New York Berlin Heidelberg SPIN 10508440
Dedicated to Dr. James L. Hedlund, a founder and
leader in Mental Health Informatics. Jim, by his
thorough scholarship and comprehensive understand
ing, provided the field with a common and comprehen
sive knowledge base. By his example, tutelage, and
friendship, he encouraged and guided my activities in the
field. He taught me to write (though he should not be
blamed for the result), to think clearly, to deliver more
than is required, and to behave with honor, humility,
and courtesy.
Matthew G. Hile
Preface
We put this book together to help mental health clinicians use computers
more effectively. With the help of my associate editors, Matthew G, Hile,
Ph.D., and Kenric W. Hammond, M.D., we have assembled a variety of
chapters that illustrate how computers can promote better care for our
patients.
Computers generally enter the mental health facility through the
business office, and sometimes do not venture beyond those walls. The
main product of a mental health system, however, is not a balance sheet
or a nicely printed bill, but mental health care. Administrators and
clinicians will want to learn about up-to-date ways in which modern
technology can help deliver better care and document ways that work the
best. Computer programs do not offer an easy answer for the
inadequately trained clinician or for the disorganized system. They can,
however, be valuable tools for the skilled clinician and can force a
thoughtful reexamination of procedures that were not carefully thought
out in the past. The combination of human skills and computer tools can
improve our delivery of mental health care.
Marvin J. Miller, M.D.
vii
Series Preface
This monograph series intends to provide medical information scientists,
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 the
exposition of these computer applications, we attempt to show what
is effective and efficient and hope to provide some guidance on the ac
quisition or design of medical information systems so that costly mistakes
can be avoided.
The health care industry is currently being pushed and pulled from all
directions-from clinicians, to increase quality of care; from business, to
lower cost and improve financial stability; from legal and regulatory
agencies, to provide detailed documentation; and from academe, to
provide data for research and improved opportunities for education.
Medical information systems sit in the middle of all these demands. The
generally accepted (popular) notion is that these systems can satisfy all
demands and solve all the problems. Obviously, this notion is naive and is
an overstatement of the capabilities of current information technology.
Eventually, however, medical information systems will have sufficient
functionality to satisfy most information needs of health care providers.
We realize that computer-based information systems can provide more
timely and legible information than traditional paper-based systems. Most
of us know that automated information systems provide, on average,
more accurate information because data capture is more complete and
automatic (e. g., directly from devices). Medical information systems can
monitor the process of health care and improve quality of patient care by
providing decision support for diagnosis or therapy, clinical reminders for
follow-up care, warnings about adverse drug interactions, alerts to ques
tionable treatment or deviations from clinical protocols, and more.
Because medical information systems are functionally very rich, must
respond quickly to user interactions and queries, and require a high level
ix
x Series Preface
of security, these systems can be classified as very complex and, from a
developer's perspective, also as "risky."
Information technology is advancing at an accelerated pace. Instead of
waiting for 3 years for a new generation of computer hardware, we are
now confronted with new computing hardware every 18 months. The
forthcoming changes in the telecommunications industry will be revolu
tionary. Certainly before the end of this century new digital communi
cations technologies, such as the Integrated Services Digital Network
(ISDN) and very high-speed local area networks using efficient cell
switching protocols (e.g., ATM) will not only change the architecture of
our information systems but also the way we work and manage health
care institutions.
The software industry constantly tries to provide tools and productive
development environments for the design, implementation, and main
tenance of information systems. Still, the development of information
systems in medicine is, to a large extent, an art, and the tools we use are
often self-made and crude. One area that needs desperate attention is the
interaction of health care providers with the computer. Although the user
interface needs improvement and the emerging graphical user interfaces
may form the basis for such improvements, the most important criterion
is to provide relevant and accurate information without drowning the
physician in too much (irrelevant) data.
To develop an effective clinical system requires an understanding of
what is to be done and how to do it and an understanding of how to
integrate information systems into an operational health care environ
ment. Such knowledge is rarely found in anyone individual; all systems
described in this monograph series are the work of teams. The size of
these teams is usually small, and the composition is heterogeneous
(i.e., health professionals, computer and communications scientists and
engineers, biostatisticians, epidemiologists, etc). The team members are
usually dedicated to working together over long periods of time, some
times spanning decades. Clinical information systems are dynamic sys
tems; their functionality constantly changes because of external pressures
and administrative changes in health care institutions. Good clinical
information systems will and should change the operational mode of
patient care, which, in turn, should affect the functional requirements of
the information systems. This interplay requires that medical information
systems be based on architectures that allow them to be adapted rapidly
and with minimal expense. It also requires a willingness by management
of the health care institution to adjust its operational procedures and
most of all, to provide end-user education in the use of information
technology. Although medical information systems should be functionally
integrated, these systems should be modular so that incremental up
grades, additions, and deletions of modules can be done to match the
pattern of capital resources and investments available to an institution.
Series Preface xi
We are building medical information systems just as automobiles
were built early in this century (191Os) (i.e., in an ad hoc manner that
disregarded even existing standards). Although technical standards
addressing computer and communications technologies are necessary,
they are insufficient. We still need to develop conventions and agree
ments, and perhaps a few regulations, that address the principal use of
medical information in computer and communication systems. Standard
ization allows the mass production of low-cost parts that can be used to
build more complex structures. What are these parts exactly in medical
information systems? We need to identify them, classify them, describe
them, publish their specifications, and, most important, use them in real
health care settings. We must be sure that these parts are useful and cost
effective even before we standardize them.
Clinical research, health services research, and medical education will
benefit greatly when controlled vocabularies are used more widely in the
practice of medicine. For practical reasons, the medical profession has
developed numerous classifications, nomenclatures, dictionary codes, and
thesauri (e.g., lCD, CPT, DSM-III, SNOWMED, COSTAR dictionary
codes, BAlK thesaurus terms, and MESH terms). The collection of these
terms represents a considerable amount of clinical activity, a large portion
of the health care business, and access to our recorded knowledge. These
terms and codes form the glue that links the practice of medicine with the
business of medicine. They also link the practice of medicine with the
literature of medicine, with further links to medical research and educa
tion. Because information systems are more efficient in retrieving infor
mation when controlled vocabularies are used in large databases, the
attempt to unify and build bridges between these coding systems is a great
example of unifying the field of medicine and health care by providing
and using medical informatics tools. The Unified Medical Language
System (UMLS) project of the National Library of Medicine, NIH, in
Bethesda, Maryland, is an example of such effort.
The purpose of this series is to capture the experience of medical
informatics teams that have successfully implemented and operated
medical information systems. We hope the individual books in this series
will contribute to the evolution of medical informatics as a recognized
professional discipline. We are at the threshold where there is not just the
need but already the momentum and interest in the health care and
computer science communities to identify and recognize the new dis
cipline called Medical Informatics.
Washington, DC HELMUTH F. ORTHNER
Contents
Preface .................................................... vii
Series Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. xvii
I. Clinical Evaluation and Treatment Software .................. 1
1. MR-E The Mental Retardation-Expert: Performance
Support for Clinicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MATIHEW G. HILE
2. Sexpert: An Expert System for Sexual Assessment,
Counseling, and Treatment .............................. 17
YITZCHAK M. BINIK, ERIC P. OCHS, and MARTA MEANA
3. Computerized Assessment System for Psychotherapy
Evaluation and Research (CASPER): Development and
Current Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
ALBERT D. FARRELL and LEIGH MCCULLOUGH-VAILLANT
4. Computer-Assisted Assessment, Psychotherapy, Education,
and Research .......................................... 54
RICHARD A. WEAVER, JEFFERY E. SELLS, and
PHILLIP W. CHRISTENSEN
5. Computerized Psychiatric Assessment in Outpatient
Practice ............................................... 67
EDWARD A. WORKMAN
Xlll