1. HeartCare, Web-based Home Support for CABG-patients

2. Background and Significance Changes in healthcare impact discharge teaching Patient-specific health information is available on the WWW

3. Features P roviding health information graduated to patient’s stage of recovery and tailored to his/her medical profile and individual needs Capitalizing on the interactive technology and health-oriented web sites to extend discharge teaching

14. Design HeartCare: Database

15. Design HeartCare Filtered set of cardiac recovery resources available on the web and self constructed web pages are stored in an Access © database. Web pages are described with index terms Index terms are also used to describe the medical profile Matching algorithm web page – patient

17. Indexing Web Pages in HeartCare Nurse-clinicians tagged web documents with: Selected concepts from Medical Language Subject Heading (MeSH), a class of Knowledge Representation Models for bio-medicine Supplemented with terms reflecting local clinical practice

18. Example of Indexing http://www.women.americanheart.org/physicians/sub_content/ten.html http://www.women.americanheart.org/physicians/sub_content/ten.html tagged with the terms “ diet “ and “ weight ” is pulled 4 different times for the menu heading “ Ten questions a woman should ask her healthcare provider ” http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/calcc b.html withterms “ Beta Blockers/Calcium Channel Blockers ” and “ Medications ” are pulled for all conditions that have the subject heading assigned, even when not applicable

19. Implications for Retrieval Issues: (1) too many pages pulled per patient (2) too many duplicate pages (3) some pages were pulled that did not exactly match the patient profile.

20. Examples of Total Web Pages in Combination with Menu title Retrieved for a Patient PatientCombinations Retrieved Unique Combinations patient 1266138 patient 2891647 patient 3324281 patient 4584203

21. Example of duplicate page retrieval for a Patient: Web Page http://rex.nci.nih.gov/NCI_Pub_Interface/Clearing_the_A ir/clearing.html, keywords smoking and behavior changes http://rex.nci.nih.gov/NCI_Pub_Interface/Clearing_the_A ir/clearing.html http://rex.nci.nih.gov/NCI_Pub_Interface/Clearing_the_A ir/clearing.html Menu Title Taking charge of your health - Week 3-6 Beginning lifestyle changes - Week 7- 12 Changing your lifestyle - Week 13-26 Condition Diabetes Hypertension Smoking Hypertension Smoking Diabetes Hypertension Smoking

22. Pages Retrieved that Does not Match the Patient’s Profile Sample Male Patient with Risk Factors Hypertension and Stress –11 different pages relating to the risk of smoking and smoking cessation –8 web pages relating to risk factors for women –5 pages specific about being overweight and weight loss –2 pages on the topic of diabetes management

23. Discussion Flawed indexing system Conceptualization problem Lacking structure of index terms

24. This study is supported by NLM/NINR Grant LM06249, Principal Investigator Dr. P.F. Brennan The authors want to thank the members from the HeartCare team for their advice and support.