Issues and Structures for Sharing Medical Knowledge Among Decision-Making Systems: The 1989 Arden Homestead Retreat

Abstract

To address the issue of facilitating transfer and integration of the variety of computer-based programs which contain medical expertise, a retreat was held at Columbia University's Arden Homestead conference center June 16-18, 1989. The focus of this retreat was to explore ways in which the medical expertise contained in knowledge-based systems could be shared and expanded. During the three day meeting, the eighteen attendees from ten institutions discussed: (a) the need for better ways of mapping terminology used in one setting or program to terms with similar meaning that have been used in other programs, (b) the need for catalogues which list the variety of programs which are available, (c) a representational syntax and format for sharing modular medical knowledge, (d) the possibility of developing standards for interfacing program modules so that they could be “snapped” into place in a variety of systems, (e) methods for evaluating, validating and testing knowledge based systems, and (f) the legal and financial aspects of sharing systems which influence the care that is given to a patient. We emerged from the retreat with a feeling that there was an enthusiastic but not unanimous consensus that sharing should occur in order to advance the field of medical information systems. We accepted an initial version of a working document for the representation of Medical Logic Modules (MLM's), appointed leaders for subcommittees to address the issues which had surfaced and settled upon an approach for dealing with the legal and financial aspects of the sharing process.

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