Symbol of the Future

26 January 2009 (Last Updated January 26th, 2009 18:30)

Could a new graphical language created by researchers in France offer a solution to complex medical referencing texts? Alex Hawkes investigates.

Symbol of the Future

As Europe's leading producer of pharmaceutical drugs, France has a rich history of adding innovation to the global drug sector. Continuing this trend, the nation looks set to revolutionise the way medical texts can be abbreviated to complement modern day technology.

First published in industry-renowned journal BMC Medical Informatics and Decision Making, the graphical language, known as VCM (Visualisation des Connaissances Medicales), is the brainchild of three independent medical researchers who identified the time-consuming nature of drug monographs that general practitioners have historically been and are still reliant on during the prescribing of drugs. Medical charts and other documents rely on old-fashioned manual transcriptions, according to the researchers, which, given the increasing industry reliance on personal data assistants (PDA), could be rejuvenated with a new type of graphical shorthand.

"It is well known that the amount of medical knowledge now available can actually prove problematic in practise and lead to an increase in prescription errors"

Co-founder and former Paris 13 University PHD student Jean-Baptiste Lamy says he believes the concept will help to reduce drug prescription errors.

"It is well known that the amount of medical knowledge now available can actually prove problematic in practise and lead to an increase in prescription errors," he explains. "If you read any drug dictionary, you can easily understand how GPs struggle to read all the corresponding pages for the patients who need to take up to ten drugs or more."

"The way to access medical information has evolved from paper to computer. However, as of yet the way to present this information has not progressed – the information is still displayed using a textual format. This format is efficient for presenting complete information but not quick enough when it comes to locating the right element of information or for obtaining a quick overview of a document.

"The objective of our iconic language VCM is therefore not to replace the existent textual representation, but to facilitate access to the right textual part and provide an overview of the information available."

Symbolic research

Research for the graphical language began in September 2003 and it took approximately three years to devise the various medical symbols and shapes. In total, 100 pictograms can be used in combination with 20 shapes to convey basic information such as a drug's side-effects or interactions and conditions, should it be prescribed. The concept is targeted at health practitioners such as physicians, pharmacists and nurses.

"The evaluation showed that physicians understood 98% of the tested VCM icons and answered 94% of the questions correctly at roughly 1.8 times faster than regular formats."

The simplistic nature of the VCM graphical icons effectively follows the steps of instantaneously recognisable modern day symbol languages such as those seen on road signs and laundry boxes. "Often we used analogies, that is to say pictograms that look like things they represent," says Lamy. "For example, a heart or a kidney is illustrated and in conjunction with a disease shape means heart or kidney disease."

The graphical icons were first tested on physicians and pharmacists at LIM&BIO – a public research laboratory in medical informatics linked to the Paris 13 University and adjoining university hospital. Following a period of refining, the language was eventually evaluated by a group of GPs, which identified that VCM increased text reading periods by almost double usual speeds.

"The evaluation showed that physicians understood 98% of the tested VCM icons and answered about 94% of the questions correctly at roughly 1.8 times faster than regular formats," says Lamy.

"The icons not only reduced the time taken for searching for information, but also highlighted how VCM reduced errors – which was an unexpected but pleasant result. Many of the GPs found it made the consultation of medical knowledge a more enjoyable experience; the system could therefore conceivably encourage physicians to consult more documentation."

Even more positive was the concept's brief training programme, which was learnt by physicians in two to seven hours. As many of the symbols are either obvious or already known by physicians, there are only a small number of remnant symbols that require revision. Additionally, the training software allows pop-up bubbles to appear on a computer screen that can prompt physicians if they forget the meaning of a particular sign.

A global language

"The French drug knowledge resource company VIDAL plans to release a VCM-powered drug dictionary during the course of 2009."

Recently a patent licence for VCM was sold to the French drug knowledge resource company VIDAL, which plans to release a VCM-powered drug dictionary during the course of 2009. Using France as its launch market, it is hoped VCM will then be exported to surrounding countries, such as Germany and Spain, before becoming global.

"We believe that VCM's iconic approach is the right way forward for presenting a large amount of medical data, information and knowledge," says Lamy. "We are currently starting another project that aims to extend the VCM graphical language and develop new applications for electronic patient records, clinical guidelines and search engines.

"For VCM to be used worldwide, certain cultural and linguistic barriers would need to be taken into account. We have tried to avoid cultural specificities throughout the VCM graphical language and therefore believe only minor modifications will be needed in all occidental cultures."