ABSTRACT We describe a clinical decision support system (CDSS) designed to provide timely information germane to poisoning.

The CDSS aids medical decision making through recommendations to clinicians for immediate evaluation. The system is implemented as a rule-based expert system with two major components: the knowledge base and the inference engine. The knowledge base serves as the database which contains relevant poisoning information and rules that are used by the inference engine in making decisions. This expert system accepts signs and symptoms observed from a patient as input, and present a list of possible poisoning types with the corresponding management procedures which may be considered in making the final diagnosis. A knowledge acquisition tool (KAT) that allows toxicological experts to update the knowledge base was also developed. This paper describes the architecture of the fully-featured system, the design of the CDSS and the KAT as web applications, the utilization of the inferencing mechanism of CLIPS (C Language Integrated Production System), which is an expert system shell that helps the system in decision making tasks, the methods used as well as problems encountered. We also present the results obtained after testing the system and propose some recommendations for future work.

COMPANY PROFILE History

A Hundred Years of the Philippine General Hospital Perhaps in no other country is the history of Modern Medicine more closely bound to the growth of its premier tertiary medical center than our own. Through one hundred years, the Philippine General Hospital (PGH) represented the healing profession's noblest goals: serving both as the refuge of countless poor sick Filipinos and as the repository of the brightest minds in Philippine Medicine. Act 1688, passed by the Philippine Commission on August 17, 1907, and heralded the birth of what was to be a familiar facade in the heart of the nation's capital, the cornerstone of which was laid a year later. From 1909 to 1910, construction began in earnest; the contract for the monumental task of erecting the medical center being awarded to H. Thurber of the Manila Construction Company for P780,000. PGH first opened its doors on September 10, 1910 with 330 beds, under the directorship of Dr. Victor Heiser. It was subsequently attached to the fledgling institution that would someday become the training ground of the country's finest physicians the Philippine Medical School, forerunner of the University of the Philippines College of Medicine (UPCM). The years that followed saw a myriad of administrative reorganizations in the hospital. In 1914, PGH became a division of the Bureau of Health, with the then Dean of UPCM Dr. William Musgrave serving as its division chief. From 1916 to 1936, decades that were also characterized by infrastructure development, the hospital was for the first time placed under the stewardship of a Filipino; Dr. Fernando Calderon served as concurrent Dean of UPCM and Director of PGH. In 1939, President Manuel Quezon transferred PGH from the Department of Public Instruction to the Office of the President. Quezon also relegated administrative and technical supervision of PGH to the UPCM Dean (who at that time was the renowned physician Dr. Antonio Sison). In 1947, through an executive order, President Manuel Roxas incorporated PGH into the University of the Philippines (UP). Seven years later, President Ramon Magsaysay bestowed upon the PGH administrative control independent of UP. A former chairman of the Department of Pediatrics, Dr. Florencio Quintos, oversaw this transition as the PGH Director. 1951-1965 was called a Reorganization and Early Modernization Period for PGH. Dr. Agerico Sison who was Dr. Quintos' predecessor led PGH in taking steps toward modernization. Specialty clinics were created (like arthritis, diabetes and thyroid clinics) as well as a heart station. Cardiac catheterization services became available. A central supply room was organized in 1952, while the dietary department began the centralization of food services. During Dr. Quintos' term, further modernization and specialization were achieved with the establishment of a radioisotope laboratory, a new operating room, an emergency room complex and the opening of new specialty clinics in Pediatrics and EENT. Significantly, the Institute of Ophthalmology formerly the Philippine Eye Research Institute was created by Republic Act 4593 on June 19, 1965, to undertake and promote researches on eye diseases in the Philippines. Organized as an administratively autonomous unit in the University of the Philippines, the Institute is functionally affiliated with the Department of Ophthalmology, UP College of Medicine and its

teaching hospital, the Philippine General Hospital. The first fifty years of PGH was celebrated during the time of Dr. Jose M. Barcelona (1958-1963). Small successes continued to the term of Dr. Francisco Tangco (1963-1966) whose service with courtesy policy became the order of the day. It was during the early years when the clinical landscape of PGH took shape. However, the clinical departments were not established at one time. Ten clinical departments were initially organized, namely: Medicine, Pediatrics, Obstetrics, Surgery, Dispensary (Outpatient), EENT, Receiving, Pathology, Physical Therapy and Private Patient. Ancillary services during the first years were provided by the Department of Pharmacy, Dietary and Domiciliary or Social Services. The Department of Obstetrics was organized in 1907 along with the founding of the College, then known as the Philippine Medical School. It offered clinical and didactic obstetrics and Dr. Fernando Calderon was its first chairman. The nucleus of the surgical department started at the Philippine Civil Hospital which was established by Act No. 247 passed by the Philippine Commission on October 1901. Dr. John R. McDill was designated chief surgeon of the PGH which later became the Philippine Medical School in 1905. When PGH was reorganized on July 1, 1910, its surgical staff merged with the Philippine Medical School and at this time, the name of the school was changed to College of Medicine and Surgery of the University of the Philippines in 1923. For a time, the surgical department was also known as the Department of Surgery and Gynecology. The gynecology service, however, became a separate department in 1923, and the surgical department was then renamed the Department of Surgery. The Department of Medicine began as a department of the Philippine Medical School, now U.P. College of Medicine. It was transferred to PGH in January 1911. Pediatrics as a specialty was just being weaned from internal medicine. All pediatric cases were managed in the Department of Medicine. In 1915, Ward 11 with a 61-bed capacity was established for clinical instruction of the Department of Pediatrics. The Outpatient Department or Dispensary opened its doors to the public on April 20, 1911. The Department of Laboratories, then a unit of the Department of Pathology and Bacteriology tasked to perform the simplest of laboratory tests blood counts; stool and urine analyses in a small room in Ward 15 became independent in 1926. Through the years, it gradually evolved to become one of the largest and most sophisticated diagnostic centers in the country. The Cancer Institute (CI) remains as the country's sole medical establishment which integrates the academic, clinical and multidisciplinary approach to screening, diagnosis and treatment of cancer. Created by Commonwealth Act 398 in 1938, the CI was established as part of the PGH and inaugurated just before World War II in October 1941. The paramedical units likewise evolved to be equally important components of the developing PGH healthcare framework. On June 10, 1915, the director of the hospital organized a unit called social and home care service with two staffs. Its main function was to extend public health nursing directly in the homes of patients. The home visits expanded in 1915 and within a year, the office became social exchange service. The new office was staffed by additional personnel from the bureau of public welfare. However, during the reorganization of the government in 1924, the original staff of two nurses was maintained. This set-up continued until 1939. Before the outbreak of World War II in 1940, the medical records section was under the supervision of the Personnel Division of the hospital. It took a series of reorganizations before the Medical Records took off as a separate division of the hospital.

The history of dietetics in the Philippines traced its roots in the Philippine General Hospital as it earned the distinction of having the first Dietary Department, serving as a model for other government and private hospitals. From 1910 until 1950, the dietary service was under the Division of Nursing. The School of Nursing trained student nurses in the planning and preparation of diets. It was in the early 1950s that then Director Agerico Sison realized the need to have a Dietary Department separate from the Nursing Service, which also played a crucial role in crafting the hospital's training potentials. When the Civil Hospital was abolished and the Philippine General Hospital came into existence, the training of nurses continued in this institution. Its affairs were managed by Mrs. Eleanor U. Snodgrass in her capacity as Chief Nurse of the PGH and superintendent of the Philippine Training School for Nurses. After Mrs. Snodgrass' death, Miss Elsie P. McCloskey (Mrs. Samuel Gaches later) was appointed in her place. In January 1915, the Philippine Legislature by Act No. 2467 again reorganized the school making it the Philippine General Hospital School of Nursing. The new law included teaching courses in midwifery and degrees conferred by authority of the Board of Regents of the University of the Philippines. In 1927, Act. No. 2711 placed the School of Nursing under the administrative supervision of the PGH Director under the visitation of the Board of Regents and the UP President. On June 12, 1937, by a resolution of the Department of Public Instruction, the Chief Nurse and Superintendent of Nurses were made responsible for the training of student nurses. In 1972, the merger of the PGH School of Nursing and UP College of Nursing was approved. At about this time, further administrative changes were made leading to the creation of the Nursing Service and its three divisions, namely: nursing administration, nursing operations and nursing research/education. The Department of Dentistry of PGH started as a dental infirmary for the City of Manila on August 13, 1912, two years after PGH was founded. The infirmary also served as the clinical section of the dental department where patients are treated by the students. The dental externship program which has been going on even before the war was the prime activity of the infirmary. The program has trained many well known dentists and treated a lot of patients from all over the country. Dr. Reginaldo Pascual's directorship from 1966-1971 was marked by a period of unrest because of the unaddressed problems of overcrowding. This was further aggravated by high nurse turnover and exodus, demands for salary increases and poor food quality. Despite these hardships, some renovation and construction projects were accomplished. Similarly, programs to strengthen PGH's mandate were implemented, thus putting the hospital in the forefront of health care delivery. Dr. Gabriel Carreon's term saw a new organizational setup for PGH with health education and training, health services and administration each under an assistant director. Republic Act No. 1870 issued on June 18, 1908 established the University of the Philippines (UP) with three initial colleges, namely: the College of Fine Arts, the College of Liberal Arts and the College of Medicine and Surgery occupying buildings distributed along Padre Faura and R. Hidalgo in Manila as well as a School of Agriculture in Los Banos, Laguna. Subsequently, Presidential Decree No. 58 issued on November 20, 1972, amended the Charter of the University. The Decree authorized the establishment of the University of the Philippines System (UPS) to effectively provide learning and leadership for social change in order to help the nation build and maintain a just, humane and democratic Filipino society. Since then, the autonomous units of the UPS are UP Diliman, UP Manila, UP Los Banos, UP Visayas, UP

Mindanao and UP Open University. The elevation of the UP College Baguio from the status of regional unit of UP Diliman to an autonomous college under the Office of the President of the University was approved at its 1131st meeting on 27th of May 1999. At the 894th meeting of the Board of Regents on October 28, 1977 and through Presidential Executive Order No. 519 dated January 24, 1979, the Health Sciences Center was created and recognized as an autonomous campus of the UP System. The Center primarily aimed to provide leadership in education, research and services that will rebound to health care of the highest quality. The recognition of the Health Sciences Center as a separate and autonomous campus of UP --- integrating all the health science units under one complex --- further redefined PGH as a national center for referral, training and research and established it's central role in the development of Philippine Medicine as it became the clinical laboratory of all these units. In November 9, 1961 BOR approved the creation of the Department of Ophthalmology and the Department of Otorhinolaryngology. In 1964, the Department of Psychiatry and Behavorial Medicine became a separate department. In1971, the BOR approved the creation of the Departments of Rehabilitation Medicine, Orthopedics and Radiology and Cancer Institute. In 1975, the Department of Pay Patient Services was recognized as a separate department. On December 18, 1975, the BOR granted academic status to the then Dept. of Outpatient Services and Community Health and renamed it the Department of Family Medicine. On January 30, 1992, the UP Board of Regents approved the creation of the Department of Emergency Medical Services. On September 30, 1999, the UP Board of Regents approved the creation of the Department of Neurosciences The great capacity of PGH in nurturing academic and clinical knowledge was evident in its early years when formal training programs were established paralleling the growth in patient care. Throughout the years, these programs are reviewed and modified accordingly with the aim of improving training and service as well. This also eventually led to the development of subspecialties as healthcare management continues to evolve and become more complex. In 1949, Dr. Quintin Gomez, who undertook post-graduate training in the United States introduced the first anesthesiology residency training for physicians in the hospital. The Department of Surgery started a distinct surgical residency training program in 1952. The scope of general surgery was also reduced with the introduction of the subspecialties neurosurgery, orthopedics, plastic surgery, colorectal surgery and pediatric surgery to name a few. The Burn Unit was formally organized by Dr. Alfredo Ramirez in 1967, the first of its kind in the country. A year later the Department of Pediatrics started their first formal residency training program and a continuing pediatric course for general practitioners with Dr. Perla Santos Ocampo as the program director. A postgraduate extension program for medical technologists was started in 1973, and a 4-year combined anatomic and clinical pathology residency training program was introduced in 1974. The same year a three-year residency training in Family Practice commenced. The '80s saw the development of additional postresidency fellowships in child psychiatry and adult psychiatry; clinical fellowships in neurosurgery, pediatric surgery and urology; a straight internship program; a formal course in eletromyography; the first Clinical Pharmacy and Pharmacy System Management Fellowship Program; and an expanded nursing residency program.

Dr. Gloria Aragon who was PGH Director from 1979-1983 was concurrent head of the PGH and Dean of the College of Medicine. During this time, the role of PGH as the National Center for Training, Service and Research in the Medical Field was intensified, translating into many developmental programs in these three areas. Several physical improvements to the already impressive center were made in the initiated by then First Lady Imelda Marcos when she commissioned Architect J. Ramos to undertake the master plan of the renovation project in 1981. The following year, the Board of Regents (BOR) approved the project and authorized then UP President Edgardo Angara to secure a P450, 000,000.00 loan from the Social Security System. Dr. Salvador Salceda who as chairman of the PGH Renovation and Expansion Project became PGH Director in 1983. Expansion formally commenced in 1985; the 8-storey Central Block Building was completed in 1990 during the time of Dr. Felipe Estrella. A modern outpatient department was built with the help of the Japanese Government's International Cooperation Agency and formally opened on April 17, 1989. A branch of the Philippine National Bank was also built inside the hospital premises in 1988. The decade was witness to the birth of two formidable donor partners of PGH in achieving its service objectives. The Friends of PGH was formally launched on October 17, 1984. The PGH Auxiliary Board was revived in September 1986 and was formally registered with the Securities and Exchange Commission on August 18, 1987. Both organizations became instrumental in saving lives of many poor PGH constituents benefited largely from their significant undertakings. Dr. Antonio Montalban succeeded Dr. Estrella in 1994. Landmark units within PGH were created, advancing its status as the biggest tertiary referral center in the country. The Spine Center constructed in 1997 is a first in the country. The Child Protection Unit, a collaborative project of the UP Manila , Philippine General Hospital, and the Advisory Board Foundation, was formally established in January 1997. After a long hiatus, the Open Heart Program of the Division of Thoracic and Cardiovascular Surgery was revived in 1994. In 1995, the PGH Bayanihan Multipurpose Cooperative was formed. The Women's Desk, a venue for abused Filipino women, was inaugurated in 1997. In 1998, the Italian Government's Arci Cultura e Sviluppo implemented the upgrading of the Neonatal and Pediatric Intensive Care Units and several service, training and research projects. An interagency referral system --Ugnayan para sa Kalusugan --- was launched in 1999. It was also at this time that the PGH Medical Foundation was incorporated. The Cardiac Catheterization Laboratory was operationalized in 1998. Seeking to gain foothold in one of the most promising areas of Medicine, the Department of Neurosciences was formed in 1999, integrating Neurophysiology, Neurology, and Neurosurgery. In 2000, the Ear Unit of the Department of Otorhinolaryngology was inaugurated, and the Surgical Research Unit and Reading Room of the Department of Surgery came about. Capping the year was the signing of a memorandum of understanding between the Spanish Government, represented no less by Queen Sofia, and the Republic of the Philippines for the construction of a comprehensive modern national facility and referral center --- the Sentro Oftalmologico Jose Rizal --- for the diagnosis and treatment of reversible blindness and other ocular disorders. This project would be carried out by the Agencia Espanola Cooperacion Internacional. Dr. Juan Ma. Pablo Naagas' thrust for facilities development and continued modernization was evident during his term. Between 2001 and 2003, additional facilities opened within the PGH complex: the Neurosciences Intensive Care Unit, Skin Bank, PGH Pfizer Virtual Library, Alfredo T. Ramirez Burn Unit, CONNECT, Patient Assessment Teaching Education Center, the Diosdado Macapagal Stroke

Center, Comprehensive Sleep Laboratory, Center for Memory and Cognition, Pediatrics Diabetes Clinic, Geriatrics Comprehensive Care Unit and Breast Clinic. Also in the same year, the Computerization Program for Cost Centers was launched and PGH achieved fiscal and administrative autonomy. Another significant milestone was the Spanish Government's DEMS Modernization Project in 2003, with Intersalus SA as implementing agency. In 2004, under the leadership of newly-appointed Director Carmelo A. Alfiler, the PGH community pulled together to accomplish projects meant to target FOR ALL, ie., Fiscal discipline, Optimal nursing services, Rational health operations, Administrative efficiency, Lucid and improved information and communications, and Leadership that is visible and governance that is responsive. Core initiatives/values that guided the implementation of these projects were expressed in simple slogans: iwas waldas, dagdag kita, magaling na, magalang pa, bagong anyo, magmalasakit, PGH muna. By touching base with all sectors in the community through regular dialogues, letters, the PGH Bulletin, and the website (www.pgh.gov.ph), Director Alfiler communicated a vision that was eventually shared and coowned by the community. He was able to secure everyone's commitment to march along a singular path. From Day One of 2004, PGH officials worked for an effective and harmonious relationship with the National Government, particularly with the Department of Budget and Management of the executive branch and both houses of Congress; the UP System and UP Manila Central Administrations; the various health science colleges and units within UP Manila (twins in interdisciplinary patient care); numerous donor/support groups in and out of the hospital and based either in the Philippines or abroad; and friends in trimedia. With the help of this vast support network, PGH was able to consistently carry out its main mandates as the premier national tertiary referral center and as clinical laboratory for the health science units. Put simply, the community's total effort translated to a significantly improved financial status for PGH to carry out its operations for 2004 and cover obligations with little difficulty; and a much-enhanced image of PGH as a public service and training facility. There was a noticeable improvement in patient care delivery; benefits/incentives to our workforce were given on time (sometimes ahead of time); and donor/support groups were given due recognition. It was also in 2004 that several projects were inaugurated or launched like (1) the upgraded and modernized Emergency Room Complex; (2) upgraded Department of Radiology Complex through the acquisition of the state-of-the-art magnetic resonance imaging (MRI) and new radiodiagnostic machines; (3) a 2-megawatt generator; (4) structural blessing of the Sentro Oftalmologico Jose Rizal; (5) Craniomaxillofacial Prosthesis and Bioengineering Unit; (6) Council for Hospital Advocacy and Media Promotive Strategies or CHAMPS which introduced the PGH website, Quickinfokits, updated media policy, and departmental informational materials; (7) Rewards and Recognition Program or Mga Pangunahing Pinahahalagahan ng PGH; (8) Stipends for postresidency fellows; (9) Interdisciplinary Staff Development Program, which pioneered the PGH Excellent Customer Service Skills Program designed by the Civil Service Commission; and (10)the PGH Association of Medical Alumni, the parent alumni association of all graduates of the internship, residency and postresidency fellowship programs since 1910. The Data Processing Center was revisited and became the Information Systems Office. Indeed, 2004 marked the year PGH once again gave true meaning to Tatak PGH by delivering what is essential

in the areas of client service, training, research and governance, raising the bar each time, and continuously setting/achieving leadership targets. For these reasons, 2004 was labeled the Turnaround Year. The year 2005 was considered a Banner Year for PGH under the Alfiler Administration. The Tatak PGH FOR ALL initiative was sustained vigorously resulting in more productivity across many areas. Through innovative and quality-centered programs, PGH managed to deliver beyond expectations. Human resource development and enhancement, independently undertaken by departments/units and via the Interdisciplinary Staff Development Committee, became top priority, so with total quality management, more personnel welfare and incentives, new trailblazing programs and PGH Centennial Celebrations 2006-2007. Preparations for the first-ever comprehensive PGH Manual of Operations as the initial important step to ISO accreditation started; these were bolstered by financial support from UP Manila. Cash incentives, non-cash livelihood programs (Ricky Reyes' Isang Gunting, Isang Suklay, massage therapy, etc.), health and non-health initiatives (Family or F-Card) and other out-of-the-box appreciation programs for the PGH faculty and staff were carried out. This year also saw the implementation of the Bantay Barangayan which involves watchers in the cleanliness program of the charity wards, the Adopt-A-Charity Ward which solicits the participation of donor groups to rehabilitate the 16 charity wards, and the Hotelization and Professionalization of the Paywayds which not only focuses on physical improvemens but also enhancement of customer service skills of Payward personnel. Other significant highlights in 2005 include the BOR's approval of the Faculty Medical Arts Building (FMAB) as the geographic outpatient pay practice area for at least 250 PGH doctors, dentists and allied health personnel, after at least 12 years of program development. Similarly, the Open Heart and Organ Transplant Units became fully operational after two years of non-use due to nursing manpower limitations. The Dialysis Unit was remarkably upgraded with 15 brand-new dialysis machines and two dialysis reprocessors. The PGH Main Pharmacy was renovated through the help of the PGH Medical Foundation. The UP Health Service, Dietary Kitchen, and Visitors Holding Area (People's Lounge), to name a few, were also renovated for the benefit of PGH constituents and patients. Healing gardens sprang in and out of the hospital complex. The number of donor/support groups contributing to patient care, infrastructure improvement, and equipment procurement and departmental/unit supplies geometrically increased. Aside from the equipment acquired for the ER and Sentro projects, PGH was fortunate to benefit from senators' Priority Development Assistance Fund (PDAF) and from international/national donors. Senate Resolution No. 40, or the One Senator-One New PGH Equipment Resolution, sponsored by Hon. Miriam Defensor Santiago, and adopted by the Senate en banc on September 6, 2005, addressed PGH's wish list of priority equipment; the adopted equipment were given fund cover subsequently by a very supportive DBM. Also highly laudable are the Adminsitration's new schemes to optimize the operations of the laboratories, radiology, operating room, paypatient and other service areas. With the PGH centennial in the offing, the Alfiler Administration continues to strengthen programs in modernizing, upgrading, rehabilitating and reinventing PGH to fulfill the vision of regaining and enhancing the honored place of PGH here and abroad. For the nation that is part of this great milestone,

hopes are high that these new directions will all be for the benefit of all Filipinos, in particular the indigent and marginalized sectors of society. PGH looked forward to 2006 as its Crowning Year, as preparations reached breakneck speed to the launch of PGH Centennial Year Celebrations on August 17, 2006, within the 99th Foundation Week. Among the new or rehabilitated hospital facilities that were inaugurated or near-completion were (1) the 9 charity wards adopted by the Senate Spouses Foundation, (2) ER Complex Conference Room 220, (3) OB Admitting Section/Labor Room/Operating Room, (4) Reroofing of the Central Block's 8th Floor, Wards 2 and 4, (5) Pediatrics Subspecialty Offices, (6) School for the Chronically-Ill, to name a few. The Sentro was finally turned over to PGH in the presence of Her Excellencies Gloria Macapagal Arroyo and Leire Pajin Iraola on June 15, 2006, a few days from Dr. Jose P. Rizal's birthday. The long-delayed Compressed Air Plant System was getting realized. The Ladies of the House of Representatives and the PGH Medical Foundation promised to renovate two charity obstetric wards. The UP Medical Alumni Society in America (UPMASA) committed to renovating the PGH Science Hall. The Dining Hall will also be renovated soon and will feature a new Dining Lounge and two audiovisually-equipped conference rooms. PGH and UP Diliman Colleges of Architecture and Engineering forged an agreement to cooperate in the implementation of PGH and UP centennial projects. PGH offered expanded health benefits to the UP System and started a more systematic referral network with UP infirmaries. At the homestretch of 2006, PGH continues to firm up and strengthen its national and international linkages to help make a bigger difference and be more relevant into 2007 and beyond. Last May 1, 2006, President Arroyo publicly announced the allocation of P100 Million allotment to rehabilitate PGH. P80 Million will be used to acquire a multislice CT scan, gamma camera, high-dose rate brachytherapy, color doppler ultrasound machine. P16 Million will cover the renovation of the whole Right Central Block's fourth floor. P4 Million will go to new services: the Health Promotion Unit at the OPD and a fully-fitted mobile health van for Tatak PGH Plus Networking. (Tatak PGH Plus refers to Expanded Health Services for the Poor in NCR LGUs and in Selected Regional Hospitals; it is both sharing PGH's wellknown leadership skills and best practices with DOH hospitals in the form of surgical-medical activities for indigent patients and capacity building for hospital personnel, and laying the foundations for a more rational networking program between PGH and these hospitals). We are expecting another P40 Million from the President through DBM and the Department of Health for the latter project and for in-hospital centennial activities. UPMASA is going to help us with the Clinical Trials Office to generate quantity and quality in research and at the same time ensure additional funds for PGH needs. This will greatly increase the work of the newly-created Expanded Hospital Research Office at PGH for both medical and nonmedical researchers. The US Embassy is very optimistic in extending financial help in the restoration of the Botong Francisco murals, and in starting a project for hydrocephalus patients. Interuniversity and inter-hospital collaboration between PGH and foreign institutions is being explored with the help of UP Manila. On the occasion of the 99th Foundation Week, the following projects and programs will be inaugurated, blessed or launched to further improve the services PGH provides. Within the next months, we hope to jump start these big-ticket projects: (1) PGH-OWWA Health Care (100 for 100) Campaign; (2) the Linear Accelerator Project; (3) Computerization Of Medical Records and Hospital Management

Systems; (4) ISO certification, (5) Commissioning of a 5th PGH Lobby Mural, and; (6) 15-Storey Multipurpose Legacy Building, to name a few. Indeed, PGH has a lot of success stories to tell as the whole nation shares in these great milestones. From its humble beginnings, PGH has risen to become the largest government healthcare institution whose main legacy of helping the sick and poor is undoubtedly unmatched. Hopes are high that the next generation of leaders and hospital personnel will continue to build on the strong foundations laid down by the many men and women who dedicated their lives and efforts for the ultimate benefit of healthy and sick Filipinos, particularly the marginalized and underserved.

ORGANIZATION CHART

Chair Executive Vice Chair Assistant Chairs: Academic Affairs Services Special Projects Training Research Executive Assistant and Planning Officer Finance Officer Division Chiefs: General Surgery Colorectal Surgery Hepatobiliary Surgery Trauma Pediatric Surgery Urology Thoracic and Cardiovascular Surgery SICU Plastic and Reconstructive Surgery Burns Endosurgery Transplant Surgery

-Dr. Serafin C. Hilvano -Dr. Eduardo R. Gatchalian

-Dr. Jose Macario V. Faylona -Dr. Nelson D. Cabaluna -Dr. Jose Dante P. Dator -Dr. A Ericson B. Berberabe -Dr. Marie Carmela Lapitan -Dr. Crisostomo E. Arcilla, Jr. -Dr. Dennis P. Serrano -Dr. Rodney B. Dofitas -Dr. Manuel Francisco T. Roxas -Dr. Ramon L. de Vera -Dr. Eric S.M. Talens -Dr. Wilma A. Baltazar -Dr. Telesforo E. Gana, Jr. -Dr. Jose Luis Danguilan -Dr. Rafael D.J. Consunji -Dr. Francisco C. Manalo -Dr. Glenn Angelo Genuino -Dr. Crisostomo E. Arcilla, Jr. -Dr. Dennis P. Serrano

INTRODUCTION
Quality of health care has always been an issue in these modern times. Statistics show that, as of 2005, the doctor to patient ratio here in the Philippines is 1:80,000, whereas the recommended ratio by the World Health Organization is 1:20,000. Furthermore, that relatively small number of doctors is usually concentrated around the urban areas. One of the solutions to this health care problem is the development of a clinical decision support system (CDSS). A CDSS is basically a system designed to directly aid in clinical decision making in which characteristics of individual patients are matched to a computerized knowledge base for the purpose of generating patient-specific assessments or recommendations that are then presented to clinicians for consideration. One type of CDSS is a diagnostic system wherein given some patient data; it tries to come up with a conclusion regarding a particular sickness or disease. However, the preferred CDSSs are those that do not only diagnose but are also able to educate medical and health care personnel with the most recent clinical knowledge. There are already a number of CDSSs that have been developed and implemented in other parts of the world and they have been proven to be really helpful in assisting the medical practitioners, as well as improving the quality of health care. Here in the Philippines, however, our group has not heard of an implemented CDSS in our health care system yet. The group now aims to design and implement an effective CDSS for poisoning cases. Toxicology is the target medical domain because of the lack of competent human resources and resource-intensive centers for the said domain here in the Philippines. Poisoning cases also require immediate attention but the problem is that the health professionals in hospitals who handle such cases do not have enough knowledge or training for those cases. The implementation of the CDSS would help alleviate that problem. The project would extend the reach of the medical experts even to the underserved regions. Costly transportation fees and time spent in transportation would be reduced by remotely accessing the CDSS. The project would then be integrated with Project ECCS (Emergency Care and Coordination Services), which is proposed by the National Telehealth Service Program. Project ECCS aims to deliver Telehealth services for poison and trauma and to develop an electronic health record system for emergency Telehealth services. The CDSS works in such a way that given some signs and symptoms observed on a patient and applying the decision rules from the knowledge base, it would classify the possible poisoning type the patient has and give some information on its specific management procedures. Rule-based approach is employed in the CDSS because of its extensibility in knowledge use, its ability to give optimal answers, and that rules can be easily understood by medical experts. The system would allow the addition of new rules in the knowledge base through the knowledge acquisition tool (KAT). It must be emphasized that the final decision in patient management still lies with the medical experts and that the system just gives suggestions regarding the possible toxicants. To build the expert system, the group started on designing and implementing the knowledge base and the inference engine. The CLIPS expert system shell is used for these two components. Because a rule-based approach is used, the knowledge base consists of knowledge in the form of rules. For the prototype, knowledge is generally based on the book Algorithms of Common Poisonings Part 1. The inference engine, on the other hand, is also built on CLIPS, by using a simple algorithm in classifying the poisoning type when given some signs and symptoms of a patient. The inference engine is then wrapped in JClips to be available on a user interface. It returns a list of the possible poisoning types, with each type having its corresponding probability, and it also displays the specific management or treatment procedures for each poisoning type. After designing and developing the two modules, we then proceed in constructing a database and developing the knowledge acquisition tool. This tool includes designing a

user interface for the knowledge engineers and also implementing the CLIPS converter component, which basically automatically converts the input data of the toxicologists into decision rules to be stored into CLIPS files saved in the knowledge base.

Objective of the Study

To develop a clinical decision support system to provide patien-specific diagnosis and recommended treatments for poisoning-related cases. To automate the code-generation of rules based on knowledge from the medical experts through the use of a knowledge acquisition tool (KAT).

History of Expert System used

Computer Science is now getting more and more involved in the medicine and health sciences. The branch of computer science which is more actively and efficiently involved in medical sciences is Artificial Intelligence. Various Clinical Decision Support Systems have been constructed by the aid of Artificial intelligence. These systems are now widely used in hospitals and clinics. They are proved to be very useful for patient as well as for medical experts in making the decisions. Different methodologies are used for the development of those systems. The way of gathering the input data and to present output informations is different in different methodologies. Any computer program that helps experts in making clinical decision comes under the domain of clinical decision support system. An important characteristic of the Artificial Intelligence is that it can support the creation as well as utilization of the clinical knowledge. Using Artificial Intelligence we can make the systems that will have the capacity to learn and the creation of new clinical knowledge. The main objective of this paper is; to present recent trends in Clinical Decision Support Systems. And To discuss methodologies used in Health Care. HISTORY OF DECISION SUPPORT SYSTEMS IN MEDICINE Since computer was invented, it has been used for assisting medical professionals. The first research article dealing with medicine and computers appeared in late 1950s (Ledley & Lusted, 1959). Later an experimental prototype appeared in the early 60s (Warner et al., 1964). At that time limited capabilities of computer did not allow it to be a part of medical domain. In 1970s the three advisory systems: de Dombals system for diagnosis of abdominal pain (de Dombal et al., 1972), Shortliffes MYCIN system for antibiotics selection (Shortliffe, 1976), and HELP system for medical alerts delivery (Kuperman et al., 1991; Warner, 1979).1990s witnessed a large scale shift from administrative systems to clinical decision support systems.

Developer

National Telehealth Group from Computer Vision and Machine Intelligence Group of UP

Characteristics Manipulate symbolic information and data conclusion

Scope & Limitations

Limitations

ESP has some limitations. Due to the lack of sources of poisoning data wherein signs and symptoms of each poisoning type are actually ranked or assigned weights, it is currently assumed that identifying signs and symptoms are of equal weights. In some cases, when some identifying symptoms are common to many types of poisoning, several of the poisoning types are displayed as results having the same hit ratio. On the other hand, there are test cases for which one of the results of the CDSS matches the expected result but with a low hit ratio. This can be attributed to poisoning types which are characterized by only a few signs and symptoms.

SPECIFICATION & REQUIREMENTS

Hardware

Software

JDK 1.5 JClips GWT 1.4 MySQL Connector/J 5.1 Eclipse 3.2 Apache Tomcat 5.5.26 MySQL 5.0

User The system caters to two types of users: a toxicological expert and a medical attendant. Medical attendant may observe the patient suffering from poisoning-related manifestations or may directly ask the patient how he or she feels. The medical attendant then enters the signs and symptoms observed from the patient into the web based CDSS user interface Toxicological expert, on the other hand, acts as a knowledge engineer, from whom accurate and useful poisoning information will come. This toxicologist then inputs knowledge through the user interface of the knowledge acquisition tool (KAT). This tool would then save the data in the poisoning database and submit it to the CLIPS Converter of the KAT in order to update the decision rules in the knowledge base.

OPERATIONAL PROCEDURE

CONCLUSION This paper has described the implementation specifications in constructing a simple rule-based system using CLIPS. The National Telehealth Group from Computer Vision and Machine Intelligence Group of UP has developed the prototype of our expert system, primarily composed of a knowledge base, an inference engine and a simple user interface. JClips was successfully used for wrapping the CLIPS engine in Java for interoperability and most importantly, this study has shown that knowledge and information regarding the poisoning domain is convertible into decision rules. The group has also developed the knowledge acquisition tool that would be invaluable to the knowledge engineers who would be helping maintain and update the system. The application of expert systems for the diagnosis of poisoning is interesting, challenging, and hopefully useful or applicable in practice in the future here in the Philippines, to help the health attendants, to serve the patients needing urgent medical attention, especially in the underserved regions, and most of all, to improve the quality of health care.

RECOMMENDATION There are some recommendations for ESP which may be considered for future work. If more resources for poisoning data become available, the weights of identifying signs and symptoms of each poisoning type can be factored into the system. This would significantly improve the quality of the results. The system may also be extended so as to consider other important patient data aside from signs and symptoms such as the amount of toxicant ingested. Furthermore, ESP may be integrated into other systems to provide decision support and to acquire additional useful data. Examples of such applications are electronic health record systems which can provide detailed diagnoses of past patient cases, and the Unified Medical Language System (UMLS) for an improved knowledge representation in the knowledge base.

SOLUTION

ESP is a rule-based diagnostic system, such that given some patient data (e.g. symptoms); it tries to come up with a conclusion regarding the possible types of poisoning that the patient have, as well as the corresponding management procedures.

DATA DICTIONARY