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Anvita eReference: Software System Integrating Clinical Medicine with Basic Biomedical Science
Sheldon S Ball, M.D., PhD1(s.ball@anvita.info) and Vei Mah, MD2; 1Department of Medicine, Veterans Administration, Sacramento CA, and 2 UCLA, Department of Pathology and Laboratory Medicine, Veterans Administration, Sacramento CA.
Context: Both clinical and molecular information are needed from laboratory bench to patient bedside. This information needs to be structured for rapid retrieval yet be complete enough to facilitate conceptual understanding of the details. Additionally, an information system should display a certain degree of intelligence, including flexibility in accepting user input and the capacity to reason with structured information. Anvita eReference is a prototype computer application integrating clinical medicine with molecular pathology. It is a functional prototype, 17 years in development that addresses: 1) representation of medical and biological information, 2) presentation of data and 3) reasoning with this information.
Technology: Anvita is written in the object oriented programming environment of Common Lisp, the Common Lisp Object System (CLOS) and the persistent object database WOOD for handling large datasets. Anvita uses the Common LISP Interface Manager (CLIM) for display of interface objects linked directly to their semantics, thus facilitating the separation of the internal representation from the presentation of information to users. This programming environment facilitates development of a large program over decades of time. The cycle of rapid prototyping to application delivery has been employed iteratively allowing Anvita to adapt to unforeseen needs without substantial rewriting. Anvita runs on Macintosh and Windows operating systems.
Design: Anvita includes information on internal medicine, biochemistry, molecular biology, genetics, pathology, laboratory medicine, radiology, pharmacology and anatomy. It functions independently as a stand-alone application, and additionally provides direct links into the world-wide-web, to molecular and clinical databases and original literature. Recently, tools for data analysis of microarray experiments were integrated into Anvita and methods of data clustering, expression correlation, and data display have been implemented and are in further development.
Results: Anvita is a computer application/electronic reference bridging clinical medicine and biomedical science (bench to bedside) in use by practicing physicians, educators, research investigators, residents and students. The microarray tools have been applied to a study of the effects of omega-3 fatty acid on gene expression in a mouse-model for Alzheimer’s disease.
Conclusion: Anvita is a tool useful for clinical practice, education and molecular research. Integration of these domains is important because understanding the molecular mechanisms of disease will shape education and health care delivery in the future.