individuals absorb or clear medications from their bodies, a blood sample of the patient in question is analyzed with a mass spectrometer or other similar device, and the resulting spectrum identifies the actual level of all drugs in the patient’s body. Combined with information from the smart table, a profile of the patient’s compliance and pharmacokinetics for each drug is generated. The clinical significance of the smart medications table and the mass spectrometer is that together they help to reduce uncertainty by synthesizing different views into the patient’s medication history.

  • Cognitive support for health care professionals and patients to help integrate patient-specific data where possible and account for any uncertainties that remain.4

    A primary care clinician needs to monitor a patient’s heart condition. Cardiac information is provided to the clinician not in the form of tables of numbers or individual EKG plots, but rather as an overlay on a visual animated structural model of the patient’s heart (not a generic heart) derived from various imaging modalities. The system displays the relevant functional information in summary form and provides an image of the heart in operation driven by all of the data that have been collected about the patient over time. Different time scales are available for display, and the clinician can display an animated image of the patient’s heart in operation as the patient is resting or exerting himself (i.e., in near-real time), or track how the structure of the heart has changed over the last 2 years using time-lapse-like sequences. Functional histories are also available. Histories are instantly available in easy-to-read form, with different parameter histories presented on similar-looking charts normalized to z-scores and timescales, showing upper and lower “normal” and physiologic bounds.5 The clinician also has the ability to drill down to any supporting piece of information that underlies the display. The clinical significance of an animated structural model is that it drastically reduces the cognitive effort needed for the clinician to visualize the heart functioning in this particular patient, freeing her to use those cognitive resources for other related tasks. The model also helps the patient to understand the medical situation at hand and assists both clinician and patient in determining an appropriate course of action.


In this report, “cognitive support” refers to IT-based tools and systems that provide users (clinicians and patients) with the information, abstractions, and models needed to achieve the IOM’s vision of health care quality.


See, for example, Seth Powsner and Edward Tufte, “Graphical Summary of Patient Status,” The Lancet 344(8919):386-389, August 6, 1994, available at

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