Integration with other systems

Coventry CDT have been keeping statistical data on a PC since their services began in 1985. They need to collect, store and retrieve data in order to help them to monitor the demands made upon their services. This is essential for monitoring the effectiveness of its present services so that future services can be planned. A good example of this is the adoption o f a Needle and Syringe Exchange Scheme because there seemed to be an alarming large number of drug misusers who were using drugs intravenously.

In December 1988 the CDT decided to have a new database management system developed. This needed to be designed so that it was fast, user-friendly, easy to

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learn and use, and contained features to produce various reports. The CDT experts (Mr Paul Wells and his colleagues) and the Knowledge Engineer discussed the contents of the forms which were presently being used and how they could be re­ designed to capture important information which was previously hidden.

The layout and contents o f the new re-designed forms were agreed and work was started on the development of a database management system in January 1989 by the Knowledge Engineer. This system was termed the Community Drug Team Database (CDTDBase) and was developed and programmed in the dBase IV language. It contained a large number of new features and seemed to be the most suitable database package on the market at the time. It was also cheaper for the CDT to get an upgrade using their existing dBase III software, rather than spend money on a completely new package. The CDTDBase went through a number of prototypes until May 1989, when the CDT started to use it to record information on clients as well as on the use of other services which they were offering.

In November 1989 a similar system for the Needle and Syringe Exchange Scheme was developed and integrated with the CDTDBase. This was followed by the development of a prescribing system in 1996.

The Department of Health had instructed Regional Health Authorities to establish drug misuse databases. In November 1989, the Health Secretary described this as

"a very important step forward. I f we are to tackle the problem o f drug misuse successfully it is essentia! that we have better information about the pattern o f drug misuse and the impact o f services." A circular was issued on the same day requiring each region to implement a drug misuse database by 31 March 1990 (Department of Health 1989).

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The CDT provide an extensive range of confidential services and these are used by a wide audience including drug users; their relatives, friends and lovers; health professionals; and members o f the general public. The demands made on its services are always recorded on a number o f different forms. The CDTDBase consists o f five databases which reflect the main areas of the CDT's work and these have been integrated to form one system. This system replaced the previous one which the CDT staff found difficult and frustrating to use because it required the user to have detailed knowledge about dBASE III and its commands, and it was also extremely slow. It was not possible to produce useful reports and this was often done manually or by using a separate program.

The CDTDBase, which was programmed using the dBASE IV command language, solved many of these problems as it contained many advanced features which were not available with dBASE III. The CDT staff found that they were

able to use the system without any demonstrations because "the system always

made it obvious what to do next". The forms which were being used for recording data were completely re-designed as the first step towards the development of this database management system.

It is important for the CDT to monitor the demands made upon its services so that

they can plan future services by highlighting major problems. This task is

simplified by the CDTDBase because it allows the user to produce lists of individual records as well as produce more detailed reports. The reports can be requested with a number of different parameters so that different time periods, drugs and areas can be considered when analysing the data. The user could be sure that the information in the reports was consistent because the system checked for the validity, integrity and consistency of the data as it was entered.

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A Needle and Syringe Exchange Scheme was launched in June 1990 and this was being organised by the CDT who used their base and three pharmacies to operate it. In order to monitor its level o f success, a Needle and Syringe Exchange Scheme

Database was developed and integrated with the CDTDBase. The integration

provided an easier way of obtaining more detailed information on certain clients who used the Scheme.

Now, the CDT had two systems - the AIDS/HIV and Drug Misuse Knowledge Base (ADMKBase) which has been described earlier in this Chapter and the Database Management System (CDTDBase). The CDTDBase provides a simple way o f storing, managing and retrieving data on clients and the services used by many other people. The ADMKBase could be accessed independently or via the CDTDBase, and this provided the user with assistance in the form of information and advice, which could be used when providing a service to clients.

The rest of this section describes how these two systems were integrated to give

the overall database system some "intelligence". This concept could be compared

to the differential mode of access during the development of the AIDS/HIV Expert System and the Expert Advisory System.

Knowledge Acquisition

Each time their services are used, the CDT capture this use and other information on the different forms which they use depending on the type o f client and service offered. This information is then input into the CDTDBase. It is possible to input the required details and information into the CDTDBase directly, during the period of contact with the client. The ADMKBase can be used to provide the expert with

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Knowledge Base containing a rich source of information which can be accessed quickly.

The speed of information retrieval is very important, but this can sometimes be slow because the required information has to be searched from deep within the

tree-structure of the Knowledge Base. Usually, more than one piece of

information is required and this slows the process down further. However, the CDT have still found the system adequate for assisting them in providing a service to their clients. Nevertheless, they had expressed a concern about one problem when using the ADMKBase - it was not always obvious which part of the tree- structure contained the information they required. This was one of the problems highlighted during the development of the AIDS/HIV Information System (see chapter one).

When thinking about a solution to this problem, the Knowledge Engineer (also the Programmer) examined the concepts of the two systems, the services the CDT were providing and the way the two systems were being used. After some time experimenting, the Knowledge Engineer thought that it would be possible to generate the required advice and information automatically for a specific client. The client's personal details, characteristics and presenting needs as entered in the CDTDBase could be used by the ADMKBase to generate a mini tree-structure consisting of information which would be specific to the client being considered. This would be a positive step towards giving the CDTDBase some Intelligence. This was a similar idea to the one developed earlier in the construction of the

AIDS/HIV Expert Advisory System. Retrieving information by differential

diagnosis was one o f the four modes o f access, the others being menus, keywords and free-text searches.

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The first and most important phase in the development of the proposed system was the intense interviews with the experts at the CDT. The main expert used was the CDT's Team Leader, Mr Paul Wells, but other members of the CDT staff contributed because they all had experience and expertise in dealing with clients. Each expert was interviewed separately to discuss the contents of the four forms they were using to collect data. They were knowledge engineered about the advice, information and counselling which they provided for each service, and the way this changed with the drug use, details and other characteristics of individual clients.

Development

The knowledge acquisition techniques used for the development of the AIDS/HIV Expert System, Information System and Expert Advisory System have been described in chapter 2. One o f these techniques involved interviewing the experts in order to elicit their expertise. In these interviews traditional approaches for knowledge elicitation were used but these proved to be very time-consuming. The main technique used was using published sources but this too was time consuming. The knowledge engineer had to spend a long time getting familiar with the subject domain.

The knowledge acquisition techniques used during the development of the

AIDS/HIV and Drug Misuse Knowledge Base were quite different. These

involved using a self knowledge elicitation concept in the form of a computerised tool. This saved time (at least 3 months) because the knowledge engineer did not need to get familiar with the subject domain except at a very general level. Also, meetings between the knowledge engineer and the expert were focused more on the features of the self knowledge elicitation tool and so did not involve a great