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| The Road To Drug Information Systems Is Marked By Icons |
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| SciMed - Horizons | |||
| TS-Si News Service | |||
| Friday, 02 May 2008 17:00 | |||
 Symbols & Ideas. Speech and visual communication are parallel and usually interdependent means by which humans exchange information. Vision provides particularly rich information about objects and events in the outside world.
The visual language we use to record these phenomena is adaptable to the needs of communication because of the simplicity of line, shape and colour, Creating an image to communicate an idea presupposes that the qualities of line and shape, proportion and color can convey meaning directly without the use of words.
Ideograms & Icons. An ideogram, or ideograph (Gr. idea "idea" + grapho "to write"), represents an idea within a graphic symbol. It replaces a group of letters arranged according to the rules of an alphabetic language (based on phonemes of a spoken language). People can visualize their thinking and minimize verbalization. The elements in an image represent concepts in a spatial context, rather than the linear form used for words.
However, an ideogram may be too abstract for some cases of everyday use, so icons (a special case of an ideogram) can provide a more nearly representational picture of a subject. Icons can be a convenient graphical shorthand for what would be otherwise lengthy text descriptions.
Icons are very common in online applications ranging from websites to music downloads, as well as more tradional settings such as supermarket and road signage. More recently, icons have found increased use as a short form notation in medical delivery systems.
As simple examples of how icons can be used, those at the top of this sidebar can each represent a single subject. While the assignment of content may be arbitrary and influenced by cultural convention, consistent use can convey meaning.
Syntax & Grammar. The picture of the light switch denotes what it is, but also invokes a procedure for its use. Some degree of preexistent knowledge is necessary to ensure that people who view the icon can understand what it means.
Moreover, the icon stands alone. Another icon that sits beside it may have meaning, but any connections between them are accidental and subject to imposition by a person viewing the two icons. They are not a set. The only context is brought to the viewing by the viewer. It takes a set of rules and practices, understood by all users, to indicate how one icon can can act upon another one. In this way, a grammatical structure can be applied to images and used to communicate more complex concepts, particularly those that act over time.
Cultural Influences. We could say, using the icons shown above, that we better turn off the lights and lock the door. We could use the first two icons, but it would make more sense if we reversed the order shown above. That is, it would make more sense to an individual accustomed to apprehending text and symbols in a left-to-right manner. The reverse would be true in some other cultures.
Neither practice is inherently "better" in this case, but conflicts will occur if the rules are not fully understood by everyone who might seek meaning in the string of icons.
Another area influenced by the divergence of cultures is in the construction of icons in the first place. The Geneva Convention specified the sole use of a Red Cross as the symbol for humanitarian and medical vehicles and buildings to protect them from military attack.
However, the Muslim nations (primarily the Ottoman Empire and, later, Turkey) objected and preferred the Red Crescent. Persia (now Iran) opted for a red lion and sun. Even though Iran no longer uses the Persian symbol and chose the Red Crescent, it has reserved the right to take it up again at any time. The Israel Red Cross uses a Red Star of David, arguing for parity with the Christian and Muslim symbols, but it is not recognized under international humanitarian law.
In response to all this, the Red Cross movement has deliberated over a new symbol without any religious connontations but easily recognizable on the battlefield. This move may be subject to other objections and, in any case, would require further international agreement. Icons can be a convenient graphical shorthand for what would be otherwise lengthy text descriptions. They are very common in online applications ranging from websites to music downloads, as well as more tradional settings such as supermarket and road signage. Up until now, there has not been a focused attempt to bring a meaningful graphical notation to bear on medical issues.
Now, a new information icon system has been developed by researchers in France. The researchers describe their system, a graphical language for medical knowledge visualization called VCM (Visualisation des Connaissances Médicales), in the journal BMC Medical Informatics and Decision Making.  Jean-Baptiste Lamy of the University of Paris and colleagues recognized that doctors do not always recall, nor have easy access to, detailed drug information. They can refer to drug monographs, but this can be inconvenient and time consuming in a busy medical practice. Lamy and his team reasoned that a new symbolic language for drug information could speed up the process and help avoid prescribing errors. The VCM graphical language uses a small set of graphical signs, akin to laundry symbols or road signs, which may be combined to build simple sentences that convey information of the kind usually described in long-winded drug monographs, such as a drug's side effects or interactions and conditions when it should not be prescribed. The resulting system, together with the doctor's underlying medical training, can be used to help determine the appropriate prescription for the patient.
 The most recent edition of the dictionary contains about 130 pictograms displayed in 5 colors. The researchers reduced package insert and patient records to 103 central pictograms, 20 external shapes and shape modifiers, five colors, and eight top-right pictograms. Images courtesy Lamy et. al.
The dictionary includes icons that represent physiological states, life habits, diseases, symptoms, drugs, and tests. For example, current conditions of a patient are shown as red icons while risks of future conditions are orange.
• Each icon has a central pictogram that represents the anatomical or functional location of a condition or the disease a drug can treat.
• 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.
• Within the icon, shapes convey specific conditions. For example, a heart shape signifies cardiovascular diseases. Antecedent states are colored brown, current conditions are red, and risks of future conditions are orange. Lamy points out that the language "… could also be used to enrich other medical documents and for patient electronic records." The VCM grammatical rules make it possible to generate many new icons by combining a small number of primitives and reusing simple icons to build up to more complex statements. Icons can be organized into simple sentences to express drug recommendations. The researchers tested VCM with a group of volunteer general practitioners to assess whether the language is easy to learn and understand and whether it works in practice. Each practitioner underwent training to learn VCM and was then tested on the meanings of the icons and combinations of icons representing different aspects of a drug monograph. Results show that physicians read VCM significantly faster than an equivalent text, with fewer errors.
Evaluation showed that VCM was learned in 2–7 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." … "VCM can be learnt in a few hours and appears to be easy to read" says Lamy. "It will considerably speed up access to drug information."
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." VCM could be used by physicians and labs by linking the notation with drug knowledge bases. This would require a careful mapping between medical classifications and the VCM icons.
The researchers concede that cultural differences could deter broad acceptance of VCM or an equivalent approach. As Lamy says, "the green cross used to indicate drugs may have a totally different meaning in other cultures."
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