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EPoCare: Evidence at the Point of Care
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In every aspect of patient treatment, questions arise for which a search of the published medical evidence is appropriate, as it is very likely that the answer has already been found from the work of other clinicians. For example:


Q: In a child with asthma, do increased doses of inhaled corticosteroids lead to a decrease in growth?

A: Growth was significantly slower in the group receiving higher dose inhaled steroids (3.6 cm, 95%CI 3.0 to 4.2 with double dose beclometasone v 5.1 cm, 95% CI 4.5 to 5.7 with salmeterol v 4.5 cm, 95% CI 3.8 to 5.2 with placebo).
(Stuart Barton, Clinical Evidence, BMJ Publishing Group, London 2002.)


Studies have shown that searching in the literature can help clinicians in answering questions generated in patient treatment. It has also been found that if high-quality evidence is available in this way at the point of care -- for example, the patient's bedside -- clinicians will use it in their decision-making, and it frequently results in additional or changed decisions. The practice of using the current best evidence to help clinicians in making decisions on the treatment of patients is called Evidence-Based Medicine (EBM).

The EPoCare project aims to provide fast access for clinicians to EBM resources at the point of care, that is, while seeing a patient either in an office or on clinical rounds in a hospital. Clinicians will be able to query resources that summarize and appraise evidence about the diagnosis, treatment, prognosis, etiology and prevalence of medical conditions. In order to make it available at the point of care, the question-answering system is accessible using hand-held computers.

Questions are answered based on the semantics of the domain, evidence-based medicine. Both the questions and the EBM sources from which the answers are drawn are understood in terms of a lightweight ontology of evidence-based medicine. This ontology constitutes a model of the sorts of things that exist in the domain and the sorts of relationships that can hold among them. The fact that the system has such a common understanding of the queries and information sources is the key to providing accurate answers.

The Knowledge Management Lab's research on answering clinical questions is part of an interdisciplinary collaboration that involves research in several disciplines. Project members in Industrial Engineering and Cognitive Psychology are investigating the design of the system through a user-centred design process, in which requirements are elicited from end users who are also involved in the evaluation of prototypes. Project members in Database Management provide support in dealing with data sources in XML format. And project members in Health Informatics will test the influence of the system on clinical decision-making and clinical outcomes.

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  The Knowledge Management Lab is now part of the Bell University Labs


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