An oncologist contemplating treatment for diarrhea in a patient on paclitaxel, may find reports of induced typhilitis useful. Intelligent software agents, or mediators, can span the gap between the point of care and the relevant reports. Given reference to paclitaxel and diarrhea in a Computer-based Patient Record (CPR), one kind of mediator can anticipate the need for these reports and search for them in PDQ, CANCERLIT, and other knowledge sources. Mediators perform these and other tasks by making use of a domain model that relates the attributes found in the CPR to those used to access the knowledge sources. Phase I will focus on the development and testing of prototype mediators and the identification of the features of the domain model that will be required to make them work. Phase II will implement these and other mediators and the required domain model. Maintenance of the domain model will be aided by connections to the Unified Medical Language System (UMLS). Clinical Information System (CIS) and CPR vendors now recognize the commercial value of bringing knowledge to the point of care: mediators offer a standard, incremental, and generalizable method of accomplishing this objective.
