Use of a Text Retrieval System to Automate Discharge Summaries and Operative Reports

摘要

This report describes a technique to create a textual database of certain clinical text documents, discharge summaries and operative reports. After dictation and transcription, an inverted text index is created using a text retrieval engine (BRS/Search). BRS/Colleague is the searching interface.Clinical care providers and other authorized users can access the more than 20,000 Discharge Summaries and 30,000 Operative Reports from any one of more than 1200 terminals or 200 networked PCs on campus.We emphasize the importance of having an architecture for building an Integrated Hospital Information System (IHIS), as a key success factor. Reference is made to the concepts of a Progressively Automated Medical Record, Virtual Database and Clinician Workstation. The application development is described with emphasis on objectives, design principles and use of technology. Use profiles and statistics are presented. Lessons learned from the implementation are provided. Future technology strategies are discussed.