Marius Fieschi - Academia.edu (original) (raw)

Papers by Marius Fieschi

PubMed, 2003

Today, the economic and regulatory environment are pressuring hospitals and healthcare profession... more Today, the economic and regulatory environment are pressuring hospitals and healthcare professionals to account for their results and methods of care delivery. The evaluation of the quality and the safety of care, the traceability of the acts performed and the evaluation of practices are some of the reasons underpinning current interest in clinical and hospital information systems. The structured collection of users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysis. We used a modelling technique designed for manufacturing processes (SADT: Structured Analysis and Design Technique). We enhanced the initial model of activity of this method and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary from the description of a given process and to locate documents (procedures, recommendations, instructions). Aimed at structuring needs and storing information provided by teams directly involved regarding the workings of an institution (or at least part of it), the process mapping approach has an important contribution to make in the analysis of clinical information systems.

Knowledge bases of current expert systems are established by competent experts. They are not work... more Knowledge bases of current expert systems are established by competent experts. They are not worked out in one go. During system development the expert is led to make numerous changes in the knowledge base, to modify certain rules, to change his mind about the way of expressing some data in the light of results obtained from tests. Most knowledge bases are perfected by testing and correcting the existing base against cases submitted to the system. This process is lengthy and development of the base is difficult even for the more experienced experts. In some cases the expert resorts to programs which help him to refine the knowledge rules; examples of this type of program are referred to by Davis and Teiresias (1980a), Politakis (1984) and Golmard (1984). The SEEK system developed by Politakis provides advice which leads to interactive refinement of the rules. It is founded on a basis of recorded cases whose purpose is to generalize or to specialize certain rules empirically, to obtain better performances. Generalization consists in weakening a rule by suppressing one or more of its conditions. This leads to more frequent release of the rule. Specialization strengthens a rule by adding one or more conditions which make its application less flexible. Golmard offers a development aid for the knowledge base of the SAM system (Gascuel, 1981) by a method of optimization of production rules weightings to cut down the development and test time which is a preliminary to time taken for validation of the rules base. These aids may be valuable but the knowledge base once constituted must be validated.

The representation of the knowledge is the main task when developing an expert system. Although, ... more The representation of the knowledge is the main task when developing an expert system. Although, for that matter, this problem is also encountered in other areas of research such as language comprehension, robotics or intelligent data bases. In fact as the representation of the knowledge is a formalism serving as medium for the phenomena being studied, the inference capacity is powerfully influenced by the choice of representation. This choice is made initially by deciding on either procedural representation or on declarative representation. A procedural representation makes clear the relationship between the elements of knowledge whilst the declarative representation attempts to express knowledge in the form of independent ‘granules’ and leaves to a reasoning mechanism the grouping of the knowledge elements for making deductions (Pinson, 1981). The details of the procedures used to represent knowledge will not be gone into. It leads to the writing of programs which are difficult to modify and extend as the knowledge develops. Schematically, if one is primarily interested in declarative representation, whether pure as in production rules and the semantic network or mixed as in frames, there are two ways of approaching the problem.

I2D, 2016

[analyse] Ne il y a une douzaine d’annees, le dossier medical personnel (DMP) serait en âge d’att... more [analyse] Ne il y a une douzaine d’annees, le dossier medical personnel (DMP) serait en âge d’atteindre l’adolescence. Les evolutions recentes et la reorientation du DMP annoncent-elles la crise bien connue de cet âge avant l’entree dans l’âge adulte ? Peut-on s’attendre a ce qu’il atteigne rapidement sa maturite ?

Yearbook of medical informatics, Aug 1, 1999

The principal objective of the Sphinx project [1] was to set up a computer system to assist physi... more The principal objective of the Sphinx project [1] was to set up a computer system to assist physicians in dealing with medical problems. The system was conceived independently of its application, i.e., to provide support for diagnostic, therapeutic, and preventive decisions. In establishing such system we asked ourselves a number of questions, such as: how to represent knowledge of different types, relating both to uncertain and to certain information; how to enable the system to take data-guided initiatives; how to set up user-system interaction; and how to run and check system knowledge.

Abstract: The approaches used by epidemiologists are diverse: they range from “field studies” for... more Abstract: The approaches used by epidemiologists are diverse: they range from “field studies” for modeling and healthcare monitoring, to methods developed for researching and combating the emergence of diseases. Their analytical tools focus on the bio-statistics used as a tool to objectify phenomena studied in well-defined populations.

Abstract: Telemedicine refers to the remote communication of information to facilitate care and t... more Abstract: Telemedicine refers to the remote communication of information to facilitate care and treatment involving voices, images, elements of the patient’s record or possibly control of a robot (e.g. a surgical one). Telemedicine is an application of information technologies aimed at improving access to care, ranging from data transfers (medical imaging or other patient data, distance education, etc.) to the practitioner’s direct intervention on the patient. The location is no longer the basis for medical practice or patient follow-up. It is no longer a question of displacing the practitioner and/or patient, but of moving the information and making it available in the appropriate time and place.

Springer eBooks, 1982

This paper presents a system for medical aided-diagnosis, the SPHINX system, based on methods of ... more This paper presents a system for medical aided-diagnosis, the SPHINX system, based on methods of inference and pattern-matching used in Artificial Intelligence and on various heuristic features: fuzzy heuristics in relation with the suggestion power of the signs and heuristics based on the costs of complementary investigations. The first application was achieved in the diagnosis of epigastric pain. Its results are presented and discussed in the paper.

Springer eBooks, 1984

The authors present a teaching aid system built around the existing expert system SPHINX for deci... more The authors present a teaching aid system built around the existing expert system SPHINX for decision aid in medicine. It is concerned in leading students to correct diagnoses of icteri. Goals and architecture of the system are presented. An example of an annoted tutorial session shows all the possibilities the system offers to students.

PubMed, 2003

Today, the economic and regulatory environment are pressuring hospitals and healthcare profession... more Today, the economic and regulatory environment are pressuring hospitals and healthcare professionals to account for their results and methods of care delivery. The evaluation of the quality and the safety of care, the traceability of the acts performed and the evaluation of practices are some of the reasons underpinning current interest in clinical and hospital information systems. The structured collection of users' needs and system requirements is fundamental when installing such systems. This stage takes time and is generally misconstrued by caregivers and is of limited efficacy to analysis. We used a modelling technique designed for manufacturing processes (SADT: Structured Analysis and Design Technique). We enhanced the initial model of activity of this method and programmed a web-based tool in an object-oriented environment. This tool makes it possible to extract the data dictionary from the description of a given process and to locate documents (procedures, recommendations, instructions). Aimed at structuring needs and storing information provided by teams directly involved regarding the workings of an institution (or at least part of it), the process mapping approach has an important contribution to make in the analysis of clinical information systems.

Knowledge bases of current expert systems are established by competent experts. They are not work... more Knowledge bases of current expert systems are established by competent experts. They are not worked out in one go. During system development the expert is led to make numerous changes in the knowledge base, to modify certain rules, to change his mind about the way of expressing some data in the light of results obtained from tests. Most knowledge bases are perfected by testing and correcting the existing base against cases submitted to the system. This process is lengthy and development of the base is difficult even for the more experienced experts. In some cases the expert resorts to programs which help him to refine the knowledge rules; examples of this type of program are referred to by Davis and Teiresias (1980a), Politakis (1984) and Golmard (1984). The SEEK system developed by Politakis provides advice which leads to interactive refinement of the rules. It is founded on a basis of recorded cases whose purpose is to generalize or to specialize certain rules empirically, to obtain better performances. Generalization consists in weakening a rule by suppressing one or more of its conditions. This leads to more frequent release of the rule. Specialization strengthens a rule by adding one or more conditions which make its application less flexible. Golmard offers a development aid for the knowledge base of the SAM system (Gascuel, 1981) by a method of optimization of production rules weightings to cut down the development and test time which is a preliminary to time taken for validation of the rules base. These aids may be valuable but the knowledge base once constituted must be validated.

The representation of the knowledge is the main task when developing an expert system. Although, ... more The representation of the knowledge is the main task when developing an expert system. Although, for that matter, this problem is also encountered in other areas of research such as language comprehension, robotics or intelligent data bases. In fact as the representation of the knowledge is a formalism serving as medium for the phenomena being studied, the inference capacity is powerfully influenced by the choice of representation. This choice is made initially by deciding on either procedural representation or on declarative representation. A procedural representation makes clear the relationship between the elements of knowledge whilst the declarative representation attempts to express knowledge in the form of independent ‘granules’ and leaves to a reasoning mechanism the grouping of the knowledge elements for making deductions (Pinson, 1981). The details of the procedures used to represent knowledge will not be gone into. It leads to the writing of programs which are difficult to modify and extend as the knowledge develops. Schematically, if one is primarily interested in declarative representation, whether pure as in production rules and the semantic network or mixed as in frames, there are two ways of approaching the problem.

I2D, 2016

[analyse] Ne il y a une douzaine d’annees, le dossier medical personnel (DMP) serait en âge d’att... more [analyse] Ne il y a une douzaine d’annees, le dossier medical personnel (DMP) serait en âge d’atteindre l’adolescence. Les evolutions recentes et la reorientation du DMP annoncent-elles la crise bien connue de cet âge avant l’entree dans l’âge adulte ? Peut-on s’attendre a ce qu’il atteigne rapidement sa maturite ?

Yearbook of medical informatics, Aug 1, 1999

The principal objective of the Sphinx project [1] was to set up a computer system to assist physi... more The principal objective of the Sphinx project [1] was to set up a computer system to assist physicians in dealing with medical problems. The system was conceived independently of its application, i.e., to provide support for diagnostic, therapeutic, and preventive decisions. In establishing such system we asked ourselves a number of questions, such as: how to represent knowledge of different types, relating both to uncertain and to certain information; how to enable the system to take data-guided initiatives; how to set up user-system interaction; and how to run and check system knowledge.

Abstract: The approaches used by epidemiologists are diverse: they range from “field studies” for... more Abstract: The approaches used by epidemiologists are diverse: they range from “field studies” for modeling and healthcare monitoring, to methods developed for researching and combating the emergence of diseases. Their analytical tools focus on the bio-statistics used as a tool to objectify phenomena studied in well-defined populations.

Abstract: Telemedicine refers to the remote communication of information to facilitate care and t... more Abstract: Telemedicine refers to the remote communication of information to facilitate care and treatment involving voices, images, elements of the patient’s record or possibly control of a robot (e.g. a surgical one). Telemedicine is an application of information technologies aimed at improving access to care, ranging from data transfers (medical imaging or other patient data, distance education, etc.) to the practitioner’s direct intervention on the patient. The location is no longer the basis for medical practice or patient follow-up. It is no longer a question of displacing the practitioner and/or patient, but of moving the information and making it available in the appropriate time and place.

Springer eBooks, 1982

This paper presents a system for medical aided-diagnosis, the SPHINX system, based on methods of ... more This paper presents a system for medical aided-diagnosis, the SPHINX system, based on methods of inference and pattern-matching used in Artificial Intelligence and on various heuristic features: fuzzy heuristics in relation with the suggestion power of the signs and heuristics based on the costs of complementary investigations. The first application was achieved in the diagnosis of epigastric pain. Its results are presented and discussed in the paper.

Springer eBooks, 1984

The authors present a teaching aid system built around the existing expert system SPHINX for deci... more The authors present a teaching aid system built around the existing expert system SPHINX for decision aid in medicine. It is concerned in leading students to correct diagnoses of icteri. Goals and architecture of the system are presented. An example of an annoted tutorial session shows all the possibilities the system offers to students.

Consumer Informatics- Applications and Strategies in Cyber Health Care, 2004

Patient empowerment can be defined as "the increasing ability of patient to actively understand, ... more Patient empowerment can be defined as "the increasing ability of patient to actively understand, participate in, and influence their health status.” Increased involvement of patients in the healthcare process is one facet of a more global trend of modern societies, where citizen no longer accept being passive about decisions that concern their lives, their environment, or their country. Patient empowerment is expected to improve outcome and be cost effective. At the am time, consumer empowerment is likely associated with the development of technologies that perpetuate or accentuate inequalities between the literate and illiterates. This chapter defends the idea that health information technologies, namely telemedicine and cybermedicine, are necessary but not sufficient conditions of patient empowerment. Change in the patient-physician relationship is a logical consequence of patient empowerment and should lead to cultural change and significant revision of education
and training program for both health professional and citizens.