Modeling a medical environment: an ontology for integrated medical informatics design

Modern medical environments have seen an increase in technological complexi ty and pressures of handling more patients with fewer resources, resulting in higher demands on medical practitioners. Medical informatics designers w ill have to focus on the problem of organizing medical information more eff ectively to enable practitioners to cope with these challenges. This articl e addresses this research problem for the particular area of medical proble m solving in patient care. First. we describe a traditional modeling approa ch for medical reasoning used as a basis for developing some decision suppo rt systems. We argue these models may be faithful to what is known about bi omedical knowledge, but they have limitations for human problem solving, es pecially in unanticipated situations. Second, we present an ontological fra mework, known as the abstraction hierarchy (Rasmussen, IEEE Trans. Man. Cyb ernetics 15 (1985) 234-243), for integrating patient representations that a re faithful to existing biomedical knowledge and that are consistent with w hat is known about human problem solving. Through an example of a critical event in the operating room, we reveal how this framework can support medic al problem solving in unanticipated situations. Third, we show how to use t hese representations as a frame of reference for mapping medical roles, res ponsibilities, sensors, and controls in an operating room context. Finally, we provide some insight for medical informatics designers in using this fr amework to design novel training programs and human-computer displays. (C) 2001 Elsevier Science Ireland Ltd, All rights reserved.