10

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter provides an overview of previous research on knowledge

sharing and intranets. It introduces the framework for the case study that

comprises the main focus of the research described in this thesis.

Related Literatures

Advanced mobile communications and portable computation are now

combined in handheld devices called smartphones, which are also capable of

running third-party software. The number of smartphone users is growing rapidly,

including among healthcare professionals. The purpose of this study was to

classify smartphone-based healthcare technologies as discussed in academic

literature according to their functionalities, and summarize articles in each

category. Recent years have seen an increased adoption of smartphones by

healthcare professionals as well as the general public. The smartphone is a new

technology that combines mobile communication and computation in a handheld-

sized device, facilitating mobile computing at the point of care.

The main stakeholders in the healthcare process are healthcare consumers

or the patients. Consumer-oriented care, where patients are directly involved in the

process of care, will greatly improve the healthcare process. Technology can play

key roles in consumer-oriented healthcare for example, making information

accessible to consumers, integrating consumers’ preferences into HISs, remote

monitoring, communication. Which is studied in a branch of medical informatics

 11

called Consumer Health Informatics (CHI). The management of diseases with

chronic conditions is very costly.1

Smartphone usage had spread in many settings including that of healthcare

with numerous potential and realized benefits. The ability to download custom-built

software applications (apps) has created a new wealth of clinical resources

available to healthcare staff, providing evidence-based decisional tools to reduce

medical errors. Previous literature has examined how smartphones can be utilized

by both medical student and doctor populations, to enhance educational and

workplace activities, with the potential to improve overall patient care. However,

this literature has not examined smartphone acceptance and patterns of medical

app usage within the student and junior doctor populations.

Smartphones have become ubiquitous among the general public.

From internet to email, they offer on the go access to information never before

possible. Within the healthcare population, the utilization of smartphone and other

mobile devices, such as the personal digital assistant (PDA) and handheld tablets,

has the potential to have a positive impact upon patient care. Specifically, by

providing personnel with immediate access to medical and health information, this

technology can lead to improved decision-making and reduced numbers of

medical errors, improved communication between hospital medical staff and

enhanced telemedicine capability.2

Smartphone applications—so-called apps—are becoming increasingly

popular among medical professionals. By 2015, 500 million smartphone users

 12

worldwide will be using a medical application. Studies report that over 85% of

health professionals use a smartphone, and 30–50% use medical apps in clinical

care. Apps have huge potential to improve patient practice, system efficiency and

communication by providing a quick reference tool accessible at the point of care.

To date, there are 10 000 apps available in the ‘medical section’ of Apple’s ‘App

store’ and over 3000 on Google’s ‘Play store’. Since these platforms facilitate

development and distribution of mobile applications by clinicians and other

developers, rapid proliferation of the market will likely continue. However, there

has been minimal description of the dangers posed by medical apps within medical

literature.

Recent studies have addressed the lack of evidence and professional

medical involvement in their design and development, raising concerns regarding

the reliability and accuracy of their medical content, and the consequences for

patient safety. It has been proposed that medical apps should be peer-reviewed

by clinical experts and that regulatory measures should be increased in order to

safeguard quality of care. Regulation and guidance are urgently needed. Medical

professionals must be made aware that some apps contain unreliable, non-peer-

reviewed content so that they can choose carefully which apps to use in clinical

care. In this paper, we propose possible strategies that could enable the medical

app market to be controlled and evidence based, while simultaneously minimizing

unnecessary bureaucracy so as not to hinder app development. The advances in

mobile health technology and the adoption of smart phones means that medical
 13

apps will be of vital importance and an integral part of daily medical practice in the

near future.

But while the rapid development of medical apps is engaging the attention

of healthcare professionals and improving accessibility to medical knowledge,

there is increasing concern regarding the potential dangers related to the use of

medical apps. We are convinced that, to some degree, medical apps should be

regulated, and that they need to be thoroughly peer reviewed in order to ensure

validity. Medical applications should have an assured quality, be scientifically

sound and cost-effective in their use.3

The Department of Health (DOH) of the Philippines is mandated to be the

over-all technical authority on health that provides national policy direction and

develop national plans, technical standards and guidelines on health. It is also a

regulator of all health services and products, and provider of special or tertiary

health care services and of technical assistance to other health providers

especially to local government units. The implementation of Kalusugan

Pangkalahatan or Universal Health Care is directed towards ensuring the

achievement of the health system goals of better health outcomes, sustained

health financing and responsive health system.4

UNA I.T. SOLUTIONS, the company behind the Health Lifestyle app called

GetMed, envisions the product to revolutionize healthcare in the Philippines. The

company was built in collaboration with some of the country’s profile experts in

pharma, information technology, and consumer marketing – all coming together

for one direction – to develop a product that would give everybody an upper hand
 14

in managing their healthcare, emergency or otherwise. GetMed simplifies patient

experience in just one touch of a button.

GetMed is also linked to Waze so you get to manage traffic as you proceed

with your respective appointments. GetMed is aimed at making the Philippines a

major player in the app-business, a product that is made in the Philippines that will

make us proud. Its mission is to bring healthcare at the touch of a button, manage

your healthcare more efficiently, conveniently and more precise. 5

Social support received by patients from family and community has been

identified as a key factor for success in improving medication adherence in those

patients. This pilot study aimed to investigate the usability and feasibility of PillPal,

a smartphone application that uses video-chatting as a social motivation medium

to encourage medication adherence in cardiovascular disease (CVD) patients. We

additionally gathered feedback on the Physician Calendar, an accompanying web

platform that allows clinicians to view patient adherence data generated from the

app.

Data were obtained through in-person interviews in which patients tested

out the app and answered standardized questions regarding the app’s feasibility

as a means to enhance social support, as well as its usability measured in terms

of ease of use and patient comfort level with the video-chat technology. The PillPal

application helps increase their motivation to take their medications; 96.7% stated

the app was easy to use; and 70% stated they were comfortable with video-

chatting while taking their medications. Patient factors such as current adherence
 15

level, disease severity, and personality were more predictive of positive app

reviews than the perceived level of social support.

Clinicians generally approved of the Physician Calendar, as they would be

able to quickly screen for non-adherence and begin conversations with patients to

address the root cause of their non-adherence. Based on pilot testing and

interviews, using a smartphone app for video-chatting as a social support medium

to improve patient medication adherence is feasible and has potential to increase

medication adherence depending on certain patient characteristics. The Physician

Calendar was deemed a useful tool by clinicians to quickly identify and understand

reasons for medication non-adherence.6

An organized health-monitoring and data-gathering system will make

patient monitoring and case-by-case treatment to make it easier. With the

development of advanced mobile computing technology and interface able

portable medical devices, this project aims to develop a health monitoring system

with its cost-effectiveness, ease of data acquisition as features. To help some life-

threatening conditions such as diabetes, hypertension and other cardiovascular

diseases that becomes more common, the need to change one's eating habits and

to monitor one's lifestyle have become a necessity. It is because, going to the

doctor frequently is very expensive, and preventive self-monitoring is now more

practical and cost-effective.7

 16

Many apps are developed for a target audience of healthcare workers,

including physicians, nurses and assistants. These apps are generally more

sophisticated, with medical terminology and functions, and not easily navigable by

non-health professionals. In a study published in 2012, a group of surveyed

healthcare workers indicated the most popular categories of mobile applications

functions include drug-referencing tools, clinical decision-support tools,

communication, electronic health-record system access and medical education

materials. The top apps were drug-reference guides such as ‘Epocrates’

(Epocrates, Inc.) and ‘Lexicomp’ (Wolters Kluwer), as well as clinical decision-

support reference tools such as ‘UpToDate’ (Wolters Kluwer) and ‘Medscape’

(WebMD LLC).

This examines the state of the art in mobile clinical and health-related apps.

A 2012 estimate puts the number of health-related apps at no fewer than 40,000,

as healthcare professionals and consumers continue to express concerns about

the quality of many apps, calling for some form of app regulatory control or

certification to be put in place. Describe the range of apps on offer as of 2013, and

then present a brief survey of evaluation studies of medical and health-related

apps that have been conducted to date, covering a range of clinical disciplines and

topics. Our survey includes studies that highlighted risks, negative issues and

worrying deficiencies in existing apps.8

Mobile phones are becoming increasingly important in everyday life and

now in healthcare. There has been a steady growth of information and

communication technologies in health communication and technology is used

 17

progressively in telemedicine, wireless monitoring of health outcomes in disease

and in the delivery of health interventions. Mobile phones are becoming an

important method of encouraging better nurse-patient communication and will

undoubtedly increase in application over coming years. This article presents recent

developments and applications of mobile technology for health promotion and

patient-monitoring in chronic disease.9

The constantly growing medical requirements have been the biggest reason

for the evolution of healthcare mobility solutions. In the past, the healthcare and

life science industries were focusing more on manufacturing customized medical

equipment and devices for the hospitals and doctors. However, now they have

switched over to custom-made mobile apps that are increasingly smarter, rich in

functionality and easy to use. Some of this are the medication adherence

app for patients and senior citizens that includes reminders for medications from

various time intervals such as hourly, daily, weekly, and monthly, record

prescription, pharmacy information and medication consumption actions, manage

medications and assist hospital pharmacy refills with proactive reminders.

The aim of these solutions is to cut the health care costs and to provide the

patients with the best results. The penetration of mobile phones in healthcare

setups is increasing due to the necessity of accessing information rapidly because

the value of time here is associated with the lives of patients and not money.

Connected mobile devices are revolutionizing the way hospitals function by

creating an impact on the healthcare industry. Even some of the healthcare

giants such as Kaiser Permanente and Cigna have leapfrogged the industry by
 18

adopting the latest mobility solutions to help physicians, clinics, hospitals and life

science organizations to be more effective.

Moreover, the mobility in healthcare facilitates both healthcare institutes as

well as patients by providing a secure and an efficient exchange of clinical data in

healthcare centers.10

Expert systems were introduced by the Stanford Heuristic Programming

Project led by Edward Feigenbaum, who is sometimes termed the "father of expert

systems"; other key early contributors were Jairus Lainibo, Bruce Buchanan, and

Randall Davis. The Stanford researchers tried to identify domains where expertise

was highly valued and complex, such as diagnosing infectious diseases and

identifying unknown organic molecules. According to Feigenbaum, “successful

expert systems have focused on very narrow riches of knowledge. If they focus on

broad domains, they tend to be not powerful enough; if focused on suitably narrow

domains, the user group tends to be too small to warrant the investment involved”.

Each expert system has its own specific application such as interpretation of data,

prediction, diagnosis, design, planning, monitoring, debugging, repair, instruction,

control and the likes.11

Computers are now regarded as an important facility to man and

considering major health problems, the literatures stated above related to our study

will give background information as to how we are going to develop our system.

This will serve as a guide and basis of some facts that we will include in our system.
 19

Related Studies

Because of the continuous advancement in the technology, people are now

able to know what their probable disease just by using their smart phones and an

application capable of diagnosing diseases. This kind of innovation gave rise to

the researchers in creating ENTDEx: an Expert System using Bayesian Networks.

Based on the series of surveys and experiments conducted by the researchers,

ENTDEx has a good feedback to its users as it provides the necessary information

the users needed specifically in the field of otolaryngology.12

Out-patient medication administration has been identified as the most error-

prone procedure in modern health-care. Under or over doses due to erratic in-

takes, drug-drug or drug-food interactions caused by un-reconciled prescriptions

and the absence of in-take enforcement and monitoring mechanisms have caused

medication errors to become the common cases of all medical errors. Most

medication administration errors were made when patients bought different

prescribed and over-the-counter medicines from several drug stores and use them

at home without little or no guidance. Elderly or chronically ill patients are

particularly susceptible to these mistakes. In this paper, Wedjat, a smart phone

application designed to help patients avoiding these mistakes.

Wedjat can remind its users to take the correct medicines on time and

record the in-take schedules for later review by healthcare professionals. Wedjat

has two distinguished features: it can alert the patients about potential drug-

drug/drug-food interactions and plan a proper in-take schedule to avoid these

interactions; it can revise the in-take schedule automatically when a dose was
 20

missed. In both cases, the software always tries to produce the simplest schedule

with least number of in-takes. Wedjat is equipped with user friendly interfaces to

help its users to recognize the proper medicines and obtain the correct instructions

of taking these drugs. It can maintain the medicine in-take records on board,

synchronize them with a database on a host machine or upload them onto a

Personal Heath Record (PHR) system.

A proof-of-concept prototype of Wedjat has been implemented on Window

Mobile platform and will be migrated onto Android for Google Phones. This paper

introduces the system concept and design principles of Wedjat with emphasis on

its medication scheduling algorithms and the modular implementation of mobile

computing application.13

Medications are powerful and commonly used modern therapies that can

yield many benefits. Yet, they can also cause considerable harm especially if

prescribing clinicians fail to consider relevant patient characteristics. For example,

renal insufficiency and advanced patient age call for lower than usual medication

doses, and drug–drug interactions are sometimes lethal. Electronic health record

(EHR) systems can improve the reliability, quality, and safety of medication use.

Computerized provider order entry (CPOE) with clinical decision support (CDS)

can improve medication safety and reduce medication-related expenditures

because it introduces automation at the time of ordering, a key process in health

care.

Electronic order communication can occur instantly, accurately, and reliably

and computer-generated orders are more legible than those written by hand. A
 21

knowledge-based CDS review can assure that the order is safe and compliant with

guidelines. For CDS to be effective, adequate expertise must go into defining and

representing medical knowledge. Also, data that are critical for CDS, such as the

patient's weight and allergy status, must be captured and made available to the

CDS system. CDS systems must support, rather than impede, clinical workflows

through speedy, available, and usable algorithms that provide parsimonious, clear,

concise, and actionable warnings and advice.14

The invention of Albert R. Brill and Denis Sosnoski is a system for use in

pharmacies which uses customer inputs to assist the customer with the selection

of an appropriate non-prescription medication to relieve symptoms of an illness,

injury or the like. The system uses an expert system to perform the selection and

thereby free-up the time of the pharmacists to the extent that customers are able

to obtain information and suggestions for non-prescription medications which they

would otherwise obtain from the pharmacists. In this manner, by reducing the

amount of time needed by the pharmacists to answer customer questions relating

to non-prescription medications, the pharmacists are able to devote more time to

the filling of prescriptions and other required tasks. The system utilizes a personal

computer with appropriate programming for prompting a user to input information

which is used by a knowledgebase to determine non-prescription medications

which may be purchased by the customer to relieve symptoms of injuries and

illnesses covered by the knowledgebase. 15

 22

Inventors of Prescription reminder system and method Howard W. Dawson,

Jr., Gregory Bryan on Apr. 22, 1997 invented the prescription reminder system and

method provides patients with paging devices, and uses a database of information

about the patients and their prescriptions to generate reminder signals. This

invention relates generally to systems and methods of reminding patients when it

is time to take medications and specifically to systems and methods by which

prescription information is transmitted to and processed by a data to remind the

patient that it is time to take a dose of the prescribed medication. The problem is

most often observed among patients taking multiple medications, patients taking

medications with complicated administration schedules, and patients on long term

drug therapy regimens. The information concerning a prescription is a message

that a dose of medication is due to be taken, and wherein the patient pager device

displays the message. 16

Using mobile technologies for tele-health in developing nations requires

dealing with many standards, different networks and local challenges ranging from

intermittent connectivity and cultural differences. Moca is a cell phone-facilitated

clinical information system that allows transmission of any medical file, whether a

photo, x-ray, audio or video file, through a cell phone to a central server for

archiving and incorporation into an electronic medical record, and a remote

specialist for real-time decision support.

According to Leo Anthony Celi, Luis Sarmenta, Jhonathan Rotberg, Alvin

Marcelo, and Gari Clifford, for the Moca Team. Mobile Care (Moca), the open

source software is designed as an end-to-end clinical information system that

 23

seamlessly connects health care workers to medical professionals. It is integrated

with OpenMRS, an existing open source medical records system commonly used

in developing countries.17

Misinterpreted drug names in medical prescriptions cause severe and lethal

effects to patients. This is caused by either illegible handwriting or inability of

pharmacists to recognize medicine names in medical prescription. This study

resolves the problems in medical prescriptions through MediPic, an Android

application that uses optical character recognition to partially scan handwritten

medicine names and return readable digital text. This mobile application used

Tesseract as the optical character recognition library, and Repres to match the

partial string with the drug name. With MediPic, cases of misinterpretation of

medicine names can be decreased. This will help pharmacists minimize their

doubts in selling the wrong medicine to patients. This will also be handful to the

patients because it will provide a way to know more about the medicine they are

about to take.18

With the aim to provide the public with an easier access to healthcare

services, St. Luke's Medical Center launched its first mobile application, the

St.Luke's MedConnect. The app is the first and fully functional application for the

healthcare industry to bring the hospital's world-class services closer to the public

anytime, anywhere. It includes features like accessing one's laboratory results and

reading about essential information such as health tips and information about

various diseases. Accessing the app is absolutely free when you have a stable Wi-

Fi connection while data charges may apply depending on the standard rates of
 24

different network carriers. However, you can still access the Emergency Care

Services when you're offline.19

In this study a clinical decision support system (CDSS) is a software system

that aids medical decision making and suggests recommendations to clinicians for

evaluation in a short length of time. Developing a CDSS for poisoning cases can

compensate for the lack of specialized resource-intensive center in the Philippines.

The CDSS is implemented as a rule-based expert system with two major

components - the knowledge base and the inference engine.

The project also involves the development of a knowledge acquisition tool

(KAT) that would allow the addition of knowledge into the knowledge base. This

paper describes the development of the knowledge base and the inferencing

engine of our CDSS; the utilization of the inferencing mechanism of CLIPS, which

is an expert system shell; the algorithms used as well as the problems

encountered; the results observed after testing the program; and also the possible

solutions and adjustments which could be done for the improvement and efficiency

of the CDSS.20

Clinical Guidelines (CG) are useful for physicians. However, guidelines

printed on paper are difficult to use efficiently during medical consultation. This has

led to the development of decision support systems (DSS) based on the CG. The

ASTI project in France provides an example of such a system. This DSS aims to

improve therapeutic care for patients with chronic diseases, by helping physicians

to take into account the recommendations expressed in CG. ASTI includes a

 25

critiquing module — a rule-based system composed of a knowledge base and an

inference engine.

This module is automatically activated when the physician writes a drug

prescription; it compares the treatment proposed by the physician with that

recommended by the CG, and issues an alert if they differ. ASTI has been applied

to several chronic diseases, including type 2 diabetes. The Quinlan C4.5

Algorithms used to build a decision tree from an exhaustive set of DSS input

vectors and outputs. This method was successfully used for the testing of a

medical DSS relating to chronic diseases. 21

Synthesis of the State-of-the-Art

The mentioned thesis simply shows that there is a great possibility for the

type of expert system to be developed and that many of these proposed systems

have been successful and useful throughout history.

The system designed by Albert R. Brill and Denis Sosnoski to assist the

customer with the selection of an appropriate non-prescription medication to

relieve symptoms of an illness motivated the researchers to develop a medical

expert system that provides the user medical prescription(s) based on the given

disease. The system will also provide a thorough presentation of meds that need

to be taken into consideration before certain medication will be taken to avoid

conflicts that may result in serious complications. The related study aims to provide

the user information and suggestions for particular meds which they would use

otherwise.
 26

The use of the Quinlan C4.5 algorithm to build a decision tree from a set of

input and output vectors in the Decision Support System by Jean-Baptiste and co

to improve therapeutic care for patients with chronic diseases by helping

physicians take into account the recommendations expressed in the clinical

guidelines to improve healthcare in real clinical situations implies that the same

algorithm applies in P.H.A.R.M.A in generating suggested medicine and

alternative herbal remedies for particular pulmonary diseases after taking into

consideration factors that may cause drug-drug interaction which might put the

user’s health at risk.

The alarm module is now helpful for the medicine intake. Out-patient

medication has been identified as the most error-prone procedure in modern

health-care. Under or over doses due to erratic in-takes, un-reconciled

prescriptions and the absence of in-take enforcement and monitoring mechanisms

have caused medication errors to become the common cases of all medical errors.

Elderly and chronically ill patients are particularly susceptible to this mistakes. To

avoid these kind of situation we add the features in our system that constantly

remind the user and it can maintain the medicine in-take records on board. We

derived the idea from the Inventors of Prescription reminder system and method

by Howard W. Dawson, Jr., Gregory Bryan and somehow similar to Wedjat.

 27

Gap Bridged by the Study

In the system designed by Albert R. Brill and Denis Sosnoski, creating a

clear and concise alert that displays sufficient information so that the clinician

understands the rationale for the interruption is limited due to inadequate current

user interface capabilities. P.H.A.R.M.A offers a broader and more thorough

presentation of meds because of the use of a web server. The addition of

alternative herbal medicine into the long list of medicine available in the Philippines

is a big boost in the app’s capability to adapt to the user’s needs and preferences.

The gathering of the user’s medicine intake history for reference in the medicine

presentation module is the system’s way to gather the necessary data for the

safety of the user. The automatic adjustment of the notification module in

accordance to the time the user’s intake will help maintain the proper interval for

medicine intake. The system log will serve as a long-term reference for further use.
 28

Notes

1
“A Systematic Review of Healthcare Applications for Smartphones”, Abu Saleh

Mohammad Mosa, Illhoi Yoo, Lincoln Sheets - BMC Medical Informatics and Decision

Making2012; 12:67, 10 July 2012.

<http://www.annualreviews.org/doi/abs/10.1146/annurev-psych-113011-143736>

2
“Bringing the Laboratory and Clinic to the Community: Mobile Technologies for Health

Promotion and Disease Prevention” (Annual Review of Psychology) Vol. 64:471-498

(Volume publication date January 2013) First published online as a Review in Advance on

September 17, 2012.

<https://doi.org/10.1146/annurev-psych-113011-143736>

3
“Medical apps for smartphones: lack of evidence undermines quality and safety”, Arthur

Willem Gerard Buijink, Benjamin Jelle Visser, Louise Marshall - Evidence-Based

Medicine Online First, published on August 25, 2012 as 10.1136/eb-2012-100885.

<https://www.researchgate.net/profile/Benjamin_Visser2/publication/230742554_

Medical_apps_for_smartphones_Lack_of_evidence_undermines_quality_and_safety/lin

ks/0a85 e5380e887b3b79000000/Medical-apps-for-smartphones-Lack-of-evidence-

undermines-quality-and-safety.pdf>

4
“Philippines eHealth Strategic Framework and Plan 2013-2017”

<http://www.doh.gov.ph/sites/default/files/Philippines_eHealthStrategicFrameworkPlan_

February02_2014_Release02.pdf>

5
“GetMed: New Interactive Health Lifestyle App Revolutionizes Healthcare in the

Philippines”, Arthur John Abarquez, Paolo Castaño and Chris Hatton.

< http://www.raindeocampo.com/2015/01/21/getmed-new-interactive-health-lifestyle-app-

revolutionizes-healthcare-philippines/>
 29

6
“Pilot study of a smartphone application designed to socially motivate cardiovascular

disease patients to improve medication adherence”, Saki Fujita, Isaree Pitaktong, Graeme

Vosit Steller, Victor Dadfar, Qinwen Huang, Sindhu Banerjee, Richard Guo, Hien Tan

Nguyen, Robert Harry Allen, Seth Shay Martin; January 2018.

<http://mhealth.amegroups.com/article/view/17897>

7
“An Android phone Application for a health monitoring system with integrated medical

devices and localized health information and database for healthy lifestyle changes”,

Jedd Emille Chua, John Amiel Zaldua, Thomas Joseph Sevilla, Mark John Tapel, Michael

Ray Orlino, Rasing Daniel Camilo, Lee-Ramos Catherine Manuela –IEEE; Palawan,

Philippines; 22 January 2015.

<http://ieeexplore.ieee.org/abstract/document/7016204/>

8
“Mobile medical and health apps: state of the art, concerns, regulatory control and

certification”, Online J Public Health Inform. 2014; 5(3): 229; 2014 Feb. 5.

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959919/>

9
“Innovation in practice: mobile phone technology in patient care”, Dr Holly Blake; School

of Nursing. University of Nottingham; September 27, 2013.

<https://www.magonlinelibrary.com/doi/10.12968/bjcn.2008.13.4.29024>

10
“How healthcare mobile apps help doctors and patients”, Sulakshana Iyer; Sep. 13,

2016.

<http://www.softwebsolutions.com/resources/healthcare-mobile-app-development-

services.html>

11
“Edward Feigenbaum, 1977. Paraphrased by Hayes-Roth, et al.”

<https://books.google.com.ph/books?id=1-

JyAwAAQBAJ&pg=PA130&lpg=PA130&dq=quotations+by+edward+feigenbaum+about+
 30

expert+system&source=bl&ots=Du5FS-

F01S&sig=dkgIEZMx1XeqQhP3kZKkSlfE_Gk&hl=en&sa=X&ved=0ahUKEwibksK6qLrV

AhWGjZQKHZ2gBY4Q6AEIWTAM#v=onepage&q=quotations%20by%20edward%20fei

genbaum%20about%20expert%20system&f=false>

12
Alonzo, A. C., Campos, J. M., Layco, L. M., Maratas, C. A., Sagum, R. A. “ENTDEx:

ENT Diagnosis Expert System Using Bayesian Networks” (2014), Web, 31 Aug. 2016,

10:17 PM.

<http://www.jacn.net/index.php?m=content&c=index&a=show&catid=34&id=135>

13
“Wedjat: A Mobile Phone Based Medicine In-take Reminder and Monitor”

<http://ieeexplore.ieee.org/document/5211229/>

14
Kuperman, MD, PhD, Bobb, RPh, Payne, MD, Avery, MB CHB, DM, Gandhi, MD, MPH,

Burns, MD, MBA, Classen, MD, MS, Bates, MD, MSc “Medication-related Clinical Decision

Support in Computerized Provider Order Entry Systems”, Journal of the American Medical

Informatics Association, Volume 14, Issue 1, 1 January 2007, Pages 29–40

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2215064/>

15
“Non-prescription drug medication screening system”, Albert R. Brill and Denis Sosnoski

– March 29, 1994.

<https://www.google.com/patents/US5299121>

16
Howard W. Dawson, Jr., Gregory Bryan inventor; Anteon Corporation, assignee.

“Prescription reminder system and method”. US patent 5,623,242. April 22, 1997.

<https://www.google.com/patents/US5623242?utm_source=gb-gplus-sharePatent>

17
“MobileCare(Moca)forRemoteDiagnosisandScreening”

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149792/#R1>

18
“MediPic: A mobile application for medical prescription” Rosaly B. Alday, Ruel M.
 31

Pagayon - Information, Intelligence, Systems and Applications (IISA), 2013 Fourth

International Conference on 10-12 July 2013.

<http://ieeexplore.ieee.org/abstract/document/6623682/>

19
“Hospital brings healthcare services to your mobile phone”, philstar.com, January 30,

2015 - 5:51pm.

<http://www.philstar.com/health-and-family/2015/01/30/1418393/hospital-brings-

healthcare-services-your-mobile-phone?nomobile=1>

20
Bandajo, Batista, Gatapia, Marcelo, Santos, Naval. “ESP (Expert System For

Poisoning): A Clinical Decision Support System for the Diagnosis and Management of

Poisoning”

<https://pdfs.semanticscholar.org/ba94/87a990f3faad1ee4d190709df9f9698352ed.pdf>

21
“Use of the C4.5 machine learning algorithm to test a clinical guideline-based decision

support system” Jean-Baptiste Lamy, Anis Ellini, Vahid Ebrahiminia, Jean-Daniel Zucker,

Hector Falcoff, and Alain Venot - Stud Health Technol Inform. 2008; 136: 223–228.

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885810/>