Road signs for physicians
According to BioMed Central, French researchers have developed a new iconic drug information system inspired by road signs. This icon system is named VCM, short for 'Visualisation des Connaissances Médicales' in French, which means 'Visualization of Medical Knowledge.' Like road signs, the VCM graphical language uses a small set of graphical signs. The current dictionary contains about 130 pictograms displayed in 5 colors. For example, current conditions of a patient are shown as red icons while risks of future conditions are orange. The physicians who tested the system learned it in a couple of hours and think this system will reduce the number of errors in drug prescriptions. But read more...
You can see on the left some examples of VCM icons for main tests to prescribe. (Credit: Jean-Baptiste Lamy, Université Pierre et Marie Curie, Paris) By the way, Jean-Baptiste Lamy's home page is very interesting if you enjoy games and free software.
The short BioMed Central news release doesn't carry much more information. So let's turn to an article published by MedPage Today, "Graphical Medical Language Aims to Reduce Prescription Errors." It tells us that the French researchers "essentially reduced a package insert and patient records to 103 central pictograms, 20 external shapes and shape modifiers, five colors, and eight top-right pictograms."
Todd Neale, the author, gives additional details about the iconic system. "The icons represent diseases, symptoms, physiological states, life habits, drugs, and tests. The central pictogram in each icon represents the anatomical or functional location of a condition or the disease a drug can treat. For example, a heart shape signifies cardiovascular diseases. The external shape distinguishes a patient's state: a circle is normal and a square or modified square is some pathological state. For instance, inflammation is denoted by flames at the top of the icon. Antecedent states are colored brown, current conditions are red, and risks of future conditions are orange."
You can see on the left some examples of VCM icons for few diseases. (Credit: Jean-Baptiste Lamy)
This research work has been published in a BioMed Central open access journal, BMC Medical Informatics and Decision Making under the name "An iconic language for the graphical representation of medical concepts" (Volume 8, Article 16, April 24, 2008). Here is a link to the abstract which starts with this background: "Many medication errors are encountered in drug prescriptions, which would not occur if practitioners could remember the drug properties. They can refer to drug monographs to find these properties, however drug monographs are long and tedious to read during consultation. We propose a two-step approach for facilitating access to drug monographs. The first step, presented here, is the design of a graphical language, called VCM".
And here are some of the results: "VCM can represent the various signs, diseases, physiological states, life habits, drugs and tests described in drug monographs. Grammatical rules make it possible to generate many icons by combining a small number of primitives and reusing simple icons to build more complex ones. Icons can be organized into simple sentences to express drug recommendations. Evaluation showed that VCM was learnt in 2 to 7 hours, that physicians understood 89% of the tested VCM icons, and that they answered correctly to 94% of questions using VCM (versus 88% using text."
The researchers conclude that "VCM can be learnt in a few hours and appears to be easy to read. It can now be used in a second step: the design of graphical interfaces facilitating access to drug monographs. It could also be used for broader applications, including the design of interfaces for consulting other types of medical document or medical data, or, very simply, to enrich medical texts."
Here is a link to the full paper (PDF format, 26 pages, 605 KB). Here is a short excerpt about how VCM could be used by physicians and labs. "In order to be used in real life, the VCM graphical language needs to be learnt by physicians, and linked with medical components such as drug knowledge bases. This link requires a mapping between medical classifications and VCM icons. The iconic language approach require that the physician learns the language. Even if the learning phase is not very long, it would probably be difficult to convince every physicians to spend even a few hours to learn VCM. However, VCM-based medical software could be designed to enable a progressive learning of the language. For example, textual labels describing VCM icons could be added as pop-up bubbles. These labels would allow the physician to progressively discover and learn VCM."
For more information, here is a link to the "VCM language learning and reference manual" (PDF format, 26 pages, 864 KB). The illustrations in this post have been extracted from this document.
You also might want to read Lamy's PhD thesis, named "Conception et évaluation de méthodes de visualisation des connaissances médicales: Mise au point d’un langage graphique et application aux connaissances sur le médicament." Here is a link to the full text (PDF format, 188 pages, 8.40 MB, 2006, in French).
Finally, there are still more work to be done before such a system could be used because of cultural differences. As Lamy says, "the green cross used to indicate drugs may have a totally different meaning in other cultures."
Sources: BioMed Central, April 23, 2008; Todd Neale, MedPage Today, April 25, 2008; and various websites
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