Prof. Dr. Klaus A. Kuhn

Academic Career and Research Areas

Professor Kuhn’s research area is digital and translational medicine, with a specific focus on integration and security architectures. He and his team develop innovative IT concepts and solutions in large national and international projects.

Professor Kuhn holds degrees in computer science, mathematics and medicine (Dipl. Inform., Dipl. Math., Dr. med., Dr. med. habil.) from the Universities of Stuttgart, Freiburg, Tübingen and Ulm. He worked at the University Hospitals of Heidelberg and Ulm. From 1996 to 2004 he held the Chair of the Department of Medical Informatics at the University of Marburg (Philipps-Universität Marburg). In parallel to this he was Chief Information Officer at the University Hospital of Marburg. In 2004 he was appointed Director of the Institute of Medical Informatics, Statistics and Epidemiology at TU Munich. He is also a member of TUM’s Department of Informatics. Between 2007 and 2011 he was president and vice-president of the German Association for Medical Informatics, Biometry and Epidemiology. Professor Kuhn was elected a Fellow of the American College of Medical Informatics (AMIA) in 2008. In 2018 and 2016 prizes were awarded to scientific work of his institute.

Selected Activities

Coordination of a consortium (DIFUTURE) in the German Medical Informatics Initiative, which is building a nation-wide infrastructure for medical data sharing. 2018-2021, 30,8 M€.

Development of an open source software system for data integration, secondary use, and biosample management, now successfully supported by a spin-off of TUM. Received BMBF funding 2010 - 2015 under the Leading Edge Cluster m4 Project

Contributions to secure data sharing in a large European biomedical data sharing project, BioMedBridges. 2012-2015

Successful application for major grants: CRC 1321, Cluster of Excellence SyNergy


Member Editorial Board, Methods Inf Med
Member Editorial Board, Int J Med Inform
Editor, Proc 12th World Congress on Health Informatics, 2007


AMIA American Medical Informatics Association

  • Election to Fellowship, American College of Medical Informatics (ACMI) 2008

GI Gesellschaft für Informatik e.V. (German Assoc. Computer Science)

  • Co-Chair, Section Computer Science and Life Sciences 2007-2013

GMDS German Association for Medical Informatics, Biometry, and Epidemiology

  • Second Vice President 2009-11
  • President 2007-9
  • First Vice President 2005-7
  • Chair GMDS/GI WG Health Information Systems 1995-2005
  • Chair of Annual National HIS Meetings
  • Founding Chair WG Health Professional Workstation 1993-1995

IMIA International Medical Informatics Association

  • Chair WG Health Information Systems 2000-2006
  • Chair of IMIA HIS Conferences 2002 Heidelberg, 2006 Lisbon

Selected Publications

  1. Karch A, Schindler D, Kühn-Steven A , Blaser R ,Kuhn KA, Sandmann L, Sommerer C, Guba M, Heemann U , Strohäker J , Glöckner S, Mikolajczyk R, Busch DH , Schulz TF , for the Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium. The transplant cohort of the German center for infection research (DZIF Tx-Cohort): study design and baseline characteristics. Eur J Epidemiol 2021 Jan 25, doi: 10.1007/s10654-020-00715-3. Online ahead of print
  2. Eicher J, Bild R, Spengler H, Kuhn KA, Prasser F. A comprehensive tool for creating and evaluating privacy-preserving biomedical prediction models. BMC Med Inform Decis Mak. 2020 Feb 11;20(1):29.  doi: 10.1186/s12911-020-1041-3.
  3. Spengler H, Lang C, Mahapatra T, Gatz I, Kuhn KA, Prasser F. Enabling Agile Clinical and Translational Data Warehousing: Platform Development and Evaluation. JMIR Med Inform. 2020Jul 21;8(7):e15918. doi: 10.2196/15918. PMID: 32706673
  4. Wiethaler M, Slotta-Huspenina J, Brandtner A, Horstmann J, Wein F, Baumeister T, Radani N, Gerland S, Anand A, Lange S, Schmidt M, Janssen KP, Conrad A, Johannes W, Strauch K, Quante AS, Linkohr B, Kuhn KA, Blaser R, Lehmann A, Kohlmayer F, Weichert W, Schmid RM, Becker KF, Quante. BarrettNET-a prospective registry for risk estimation of patients with Barrett's esophagus to progress to adenocarcinoma. Dis Esophagus. 2019 Aug 1;32(8):doz024.doi: 10.1093/dote/doz024. PMID: 31329831.
  5. Prasser F, Spengler H, Bild R, Eicher J, Kuhn KA. Privacy-enhancing ETL-processes for biomedical data. Int J Med Inform. 2019 Jun;126:72-81. Epub 2019 Mar 23. doi: 10.1016/j.ijmedinf.2019.03.006
  6. Aristizabal Prada ET, Heinzle V, Knösel T, Nölting S, Spöttl G, Maurer J, Spitzweg C, Angele M, Schmidt N, Beuschlein F, Stalla GK, Blaser R, Kuhn KA, Auernhammer CJ.Tropomyosin receptor kinase: a novel target in screened neuroendocrine tumors. Endocr Relat Cancer. 2018 May;25(5):547-560. doi: 10.1530/ERC-17-0201
  7. Prasser F, Kohlbacher O, Mansmann U, Bauer B, Kuhn KA. Data Integration for Future Medicine (DIFUTURE). Methods of Information in Medicine 2018 Jul;57(S 01):e57-65. doi: 10.3414/ME17-02-0022
  8. Bild R, Kuhn KA, Prasser F. SafePub: A Truthful Data Anonymization Algorithm With Strong Privacy Guarantees. Proceedings on Privacy Enhancing Technologies 2018 Jan 1;2018(1):67-87. doi: 10.1515/popets-2018-0004
  9. Prasser F, Gaupp J, Wan Z, Xia W, Vorobeychik Y, Kantarcioglu M, Kuhn KA, Malin B. An Open Source Tool for Game Theoretic Health Data De-Identification. AMIA Annual Symposium Proceedings 2017 (Vol. 2017, p.1430). American Medical Informatics Association.
  10. Prasser F, Eicher J, Bild R, Spengler H, Kuhn KA. A Tool for Optimizing De-Identified Health Data for Use in Statistical Classification.  2017 IEEE 30th International Symposium on Computer-Based Medical Systems (CBMS), 169-174. doi: 10.1109/CBMS.2017.105
  11. Eicher J, Kuhn KA, Prasser F. An Experimental Comparison of Quality Models for Health Data De-Identification. Studies in Health Technology and Informatics 2017;245:704-8. doi: 10.3233/978-1-61499-830-3-704
  12. Prasser F, Kohlmayer F, Spengler H, Kuhn KA. A scalable and pragmatic method for the safe sharing of high-quality health data. IEEE Journal of Biomedical and Health Informatics 2018 Mar;22(2):611-622. doi: 10.1109/JBHI.2017.2676880
    F Prasser received the Johann Peter Süßmilch-Medal of the German Association of Medical Informatics, Biometry and Epidemiology (GMDS) for this work.
  13. Brandizi M, Melnichuk O, Bild R, Kohlmayer F, Rodriguez-Castro B, Spengler H, Kuhn KA, Kuchinke W, Ohmann C, Mustonen T, Linden M, Nyrönen T, Lappalainen I, Brazma A, Sarkans U. Orchestrating differential data access for translational research: a pilot implementation. BMC Med Inform Decis Mak. 2017 Mar 23;17(1):30. doi: 10.1186/s12911-017-0424-6.
  14. Prasser F, Bild R, Kuhn KA. A generic method for assessing the quality of de-identified health data. Proc MIE 2016 at HEC 2016. August 2016. IOS Press. doi: 10.3233/978-1-61499-678-1-312.
    F Prasser received the Peter L Reichertz Prize of the European Federation of Medical Informatics for this work.
  15. Prasser F, Kohlmayer F, Kuhn KA. The Importance of Context: Risk-based De-identification of Biomedical Data. Methods Inf Med. 2016 Aug 5;55(4):347-55. doi: 10.3414/ME16-01-0012
  16. Prasser F, Kohlmayer F, Kuhn KA. Efficient and effective pruning strategies for health data de-identification. BMC Med Inform Decis Mak. 2016 Apr 30;16:49. doi: 10.1186/s12911-016-0287-2.
  17. Altmann J, Büchner B, Nadaj-Pakleza A, Schäfer J, Jackson S, Lehmann D, Deschauer M, Kopajtich R, Lautenschläger R, Kuhn KA, Karle K, Schöls L, Schulz JB, Weis J, Prokisch H, Kornblum C, Claeys KG, Klopstock T. Expanded phenotypic spectrum of the m.8344A>G "MERRF" mutation: data from the German mitoNET registry. J Neurol. 2016 May;263(5):961-72. doi: 10.1007/s00415-016-8086-3. Epub 2016 Mar 19.
  18. Kuhn KA, Bild R, Anton G, Schuffenhauer S, Wichmann HE. Connecting biobanks of large European cohorts (EU Project BBMRI-LPC). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Mar;59(3):385-9. doi: 10.1007/s00103-015-2300-9
  19. Lautenschläger R, Kohlmayer F, Prasser F, Kuhn KA. A generic solution for web-based management of pseudonymized data. BMC Med Inform Decis Mak. 2015 Nov 30;15(1):100. doi: 10.1186/s12911-015-0222-y.
  20. Kohlmayer F, Prasser F, Kuhn KA. The cost of quality: Implementing generalization and suppression for anonymizing biomedical data with minimal information loss. J Biomed Inform. 2015 Dec;58:37-48. doi: 10.1016/j.jbi.2015.09.007. Epub 2015 Sep 15
  21. Prasser F, Kohlmayer F, Lautenschläger R, Kuhn KA. ARX--A Comprehensive Tool for Anonymizing Biomedical Data. AMIA Annu Symp Proc. 2014 Nov 14;2014:984-93. eCollection 2014.
  22. Kohlmayer F, Prasser F, Eckert C, Kuhn KA. A flexible approach to distributed data anonymization. J Biomed Inform. 2014 Aug;50:62-76. doi: 10.1016/j.jbi.2013.12.002. Epub 2013 Dec 12.
  23. Oßwald A, Plomer E, Dimopoulou C, Milian M, Blaser R, Ritzel K, Mickisch A, Knerr F, Stanojevic M, Hallfeldt K, Schopohl J, Kuhn KA, Stalla G, Beuschlein F, Reincke M. Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease. Eur J Endocrinol. 2014 Aug;171(2):209-15. doi: 10.1530/EJE-14-0214.
  24. Riediger C, Mueller MW, Geismann F, Lehmann A, Schuster T, Michalski CW, Kuhn K, Friess H. Comparative analysis of different transection techniques in minor and major hepatic resections: a prospective cohort study. Int J Surg. 2013;11(9):826-33. doi: 10.1016/j.ijsu.2013.08.010. Epub 2013 Aug 28.
  25. Lauss G, Schröder C, Dabrock P, Eder J, Hamacher K, Kuhn KA, Gottweis H. Towards Biobank Privacy Regimes in Responsible Innovation Societies: ESBB Conference in Granada 2012. Biopreservation and Biobanking October 2013, 11(5): 319-323. doi: 10.1089/bio.2013.0036
  26. Kalman B, Lautenschlaeger R, Kohlmayer F, Büchner B, Kmiec T, Klopstock T, Kuhn KA. An international registry for neurodegeneration with brain iron accumulation. Orphanet J Rare Dis. 2012 Sep 17;7:66. doi: 10.1186/1750-1172-7-66
  27. Prasser F, Kemper A, Kuhn KA. Efficient distributed query processing for autonomous RDF databases. Proc 15th IntConf on Extending Database Technology, EDBT 2012. ACM New York, NY, USA, 372-383. doi: 10.1145/2247596.2247640
  28. Kohlmayer F, Prasser F, Eckert C, Kemper A, Kuhn KA. Flash: efficient, stable and optimal k-anonymity.Proc 4th IEEE IntConf on Information Privacy, Security, Risk and Trust, PASSAT 2012
  29. Wichmann HE, Kuhn KA, Waldenberger M, Schmelcher D, Schuffenhauer S, Meitinger T, Wurst SH, Lamla G, Fortier I, Burton PR, Peltonen L, Perola M, Metspalu A, Riegman P, Landegren U, Taussig MJ, Litton JE, Fransson MN, Eder J, Cambon-Thomsen A, Bovenberg J, Dagher G, van Ommen GJ, Griffith M, Yuille M, Zatloukal K.: Comprehensive catalog of European biobanks. Nat Biotechnol. 2011 Sep 8;29(9):795-7. doi: 10.1038/nbt.1958
    HE Wichmann and KA Kuhn contributed equally to this work.
  30. Feulner TM, Laws SM, Friedrich P, Wagenpfeil S, Wurst SH, Riehle C, Kuhn KA, Krawczak M, Schreiber S, Nikolaus S, Förstl H, Kurz A, Riemenschneider M.: Examination of the current top candidate genes for AD in a genome-wide association study. Mol Psychiatry. 2009 Jan 6. doi: 10.1038/mp.2008.141
  31. Kuhn KA, Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S.: Informatics and medicine--from molecules to populations. Methods Inf Med 2008; 47(4):283-95. doi: 10.3414/ME9117
  32. Kuhn KA, Guise DA, Lapao L, Wurst SHR: Expanding the Scope of Health Information Systems From Hospitals to Regional Networks, to National Infrastructures and Beyond. Meth Inf Med 2007; 46(4):500-502. doi: 10.1160/ME9058
  33. Lenz R, Beyer M, Kuhn KA: Semantic integration in healthcare networks. Int J Med Inf 2007;76(2-3): 201-7. doi: 10.1016/j.ijmedinf.2006.05.008
  34. Blaser R, Schnabel M, Biber C, Baumlein M, Heger O, Beyer M Opitz E, Lenz R, Kuhn KA: Improving pathway compliance and clinical performance by using information technology. Int J Med Inf 2007;76(2-3): 151-6. doi: 10.1016/j.ijmedinf.2006.07.006
  35. Kuhn KA, Wurst SH, Bott OJ, Giuse DA: Expanding the scope of health information systems. Challenges and developments. Yearb Med Inform 2006:43-52
  36. Beyer M, Lenz R, Kuhn KA: Health Information Systems. it Information Technology 2006: 48: 6-11.
  37. Lenz R, Buessecker F, Herlofsen H, Hinrichs F, Zeiler T, Kuhn KA: Demand-driven evolution of IT-systems in healthcare - a case study for improving interdisciplinary processes. Methods Inf Med 2005; 44: 4-10.
  38. Lenz R, Beyer M, Meiler C, Jablonski S, Kuhn KA: Informationsintegration in Gesundheitsversorgungsnetzen - Herausforderungen an die Informatik. Informatik Spektrum 2005; 28(2): 105-119.
  39. Blaser R, Kuhn KA, Overath M, Dietz F, Opitz E, Lenz R: Towards responsive IT-infrastructures - assessment of a health information system. Proc. MEDINFO 2004: 1178-82. doi: 10.1007/s00287-005-0467-4
  40. Beyer M, Kuhn KA, Meiler C, Jablonski S, Lenz R: Towards a flexible, process-oriented IT architecture for an integrated healthcare network. Proceedings of the 2004 ACM Symposium on Applied Computing (SAC); ACM, 2004: 264-271. doi: 10.1145/967900.967958
  41. Blaser R, Schnabel M, Mann D, Jancke, P, Kuhn KA, Lenz R: Using information technology to prevent medical errors in casualty surgery. Proceedings of the 2004 ACM Symposium on Applied Computing (SAC) 2004: 285-290.
  42. Lenz R, Kuhn KA: Towards a continuous evolution and adaptation of information systems in healthcare. Int J Med Inf. 2004; 73: 75-89. doi: 10.1016/j.ijmedinf.2003.09.003
  43. Lenz R, Kuhn KA: A strategic approach for business-IT alignment in health information systems. In: Meersman R, Tari Z, Schmidt DC, editors: On The Move to Meaningful Internet Systems 2003: CoopIS, DOA, and ODBASE; Springer Verlag, Lecture Notes in Computer Science, 2003: 178-195. doi: 10.1007/978-3-540-39964-3_13
  44. Giuse DA,  Kuhn KA: Health information systems challenges: the Heidelberg conference and the future. Int J Med Inf  2003; 69: 105-114. doi: 10.1016/S1386-5056(02)00182-X
  45. Kaltenborn KF, Kuhn K: Der Impact-Faktor als Parameter zur Evaluation von Forscherinnen/Forschern und Forschung. Med Klin 2003; 98(3):153-69. doi: 10.1007/s00063-003-1240-6
  46. Kuhn KA, Giuse DA, Haux R: IMIA working conference on health information systems 2002 in Heidelberg, “Practical HIS Experiences”. Meth Inf Med 2003; 42: VI-VIII.
  47. Kuhn KA, Giuse DA, Talmon JL: The Heidelberg conference - setting an agenda for the IMIA working group on health information systems. Int J Med Inf 2003. 69: 77-82. doi: 10.1016/S1386-5056(02)00097-7
  48. Lenz R, Kuhn KA: Zur Architektur und Evolution von Krankenhausinformationssystemen. In: Dittrich K, König W, Oberweis A, Rannenberg K, Wahlster W (Hrsg.): Informatik 2003 - Innovative Informatikanwendungen, Beiträge der 33. Jahrestagung der Gesellschaft für Informatik e.V.(GI); Band 2.: 2003: 435-444.
  49. Kuhn KA, Lenz R, Elstner T, Siegele H, Moll R: Experiences with a generator tool for building clinical application modules. Methods Inf Med 2003; 42: 37-44.
  50. Lenz R, Elstner T, Kuhn KA: Evolutionäre Entwicklung von Informationssystemen. Informatik Biometrie und Epidemiologie in Medizin und Biologie 2002; 33(2-3): 86-87.
  51. Lenz R, Elstner T, Siegele H, Kuhn KA: A practical approach to process support in health information systems. JAMIA 2002;9(6): 571-585. doi: 10.1197/jamia.M1016
  52. Dugas M, Kuhn K, Kaiser N, Uberla K: XML-based visualization of design and completeness in medical databases. Med Inform Internet Med 2001;26(4):237-50
  53. Kuhn KA, Giuse DA. From Hospital Information Systems to Health Information Systems - Problems, Challenges, Perspectives. Methods Inf Med 2001; 40 (4): 275-287
  54. Kuhn KA, Giuse DA, Bakker AR, Ball M.J, Gell G. Challenges in Deploying Health Information Systems. In: Patel VL, Rogers R, Haux R (eds): Medinfo 2001, Proceedings 10th World Congress on Medical Informatics, 1551. doi: 10.3233/978-1-60750-928-8-1551
  55. Lenz R, Elstner T, Blaser R, Kuhn KA. Experiences with a Holistic Health Information System. JAMIA 2001; Amia Symp. S 952.
  56. Lenz R,Kuhn KA. Intranet Meets Hospital Information Systems - the Solution to the Integration Problem? Methods Inf Med 2001; 40(2): 99-105.
  57. Dadam P, Reichert M, Kuhn K. Clinical Workflows - The Killer Application for Process-oriented Information Systems?. In: AbramowiczW., Orlowska M.E. (eds.): BIS 2000 / Proc. 4th Int Conf. on Business InformationSystems. Springer, London, 2000. doi: 10.1007/978-1-4471-0761-3_3
  58. Kuhn K, Lenz R, Blaser R: Building a Hospital Information System: Design Considerations Based on the Results from a Europe-wide Vendor Selection Process. In: Lorenzi N.M. (ed.): Proc AMIA Symposium 1999, JAMIA 1999; 6 (Symposium Suppl), 834-838.
  59. Dadam P, Kuhn K, Reichert M, Beuter T, Nathe M. ADEPT: Ein integrierender Ansatz zur Entwicklung flexibler, zuverlässiger kooperierender Assistenzsysteme in klinischen Anwendungsumgebungen. In: Huber-Wäschle F, Schauer H, Widmayer P (Hrsg.): GISI 95. Berlin, Springer, 1995, 677-686. doi: 10.1007/978-3-642-79958-7_93
  60. Kemmer TP, DominguezMunoz JE, Klingel H, Zemmler T, Kuhn K, Malfertheiner P: The association between nonulcer dyspepsia and helicobacter pylori infection. European Journal of Gastroenterology and Hepatology 1994; 6 (7): 571-577
  61. Heinlein C, Kuhn K, Dadam P. Representation of Medical Guidelines on Top of a Classification-Based System. In: Adam NR, Bhargava BK, Yesha Y (eds.), Proc 3rd Intl Conf Information and Knowledge Management(CIKM). New York, ACM Press, 1994, 415 -422. doi: 10.1145/191246.191316
  62. Kuhn K, Reichert M, Nathe M, Beuter T, Dadam P. An Infrastructure for Cooperation and Communication in an Advanced Clinical Information System. In: Ozbolt J (ed.): Proc. 18th Ann. Symposium on Computer Applications in Medical Care 1994, JAMIA 1994; 1 (Symposium Suppl): 519-523.
  63. Kuhn K, Zemmler T, Reichert M, Rösner D, Baumiller O, Knapp H. An Integrated Knowledge-Based System to Guide the Physician During Structured Reporting. Methods Inf Med 1994; 33: 417-422.
  64. Kuhn K, Reichert M, Nathe M, Beuter T, Heinlein C, Dadam P. A Conceptual Approach to an Open Hospital Information System. In: Barahona P, Veloso M, Bryant J (eds.): Proc. 12th Intl. Congr. Europ. Fed. Med. Inf. (MIE 94), Lisbon, 1994: 374-378.
  65. Kuhn K, Zemmler T, Reichert M, Heinlein C, Roesner D. Structured Data Collection and Knowledge-Based User Guidance for Abdominal Ultrasound Reporting. In: Safran C (ed.): Proc. 17th Ann. Symposium on Computer Applications in Medical Care 1993. New York: McGraw-Hill 1993, 311-315.
  66. Koenig W, Hehr R, Ditschuneit HH, Kuhn K, Ernst E, Rosenthal J, Hombach V: Lovastatin alters blood rheology in primary hyperlipoproteinemia: dependence on lipoprotein(a)? J Clin Pharmacol 1992; 32(6):539-45. doi: 10.1177/009127009203200609
  67. Janowitz P, Wechsler JG, Kuhn K et al:  Increased gallbladder residual volume in nonresponders to extracorporeal shock wave lithotripsy of gallbladder stones. Am J Gastroenterol 1992; 87(10):1429-32
  68. Kuhn K, Gaus W, Wechsler JG, Janowitz P, Tudyka J, Kratzer W, Swobodnik W, Ditschuneit H. Structured Reporting of Medical Findings: Evaluation of a System in Gastroenterology. Methods Inf Med 1992; 31: 268-274.
  69. Kuhn K, Swobodnik W, Johannes RS, Zemmler T, Stange EF, Ditschuneit H, Classen M. The Quality of Gastroenterological Reports Based on Free Text Dictation - an Evaluation for Endoscopy and Ultrasonography. Endoscopy 1991; 23: 262-264. doi: 10.1055/s-2007-1010682
  70. Kuhn K, Kottmann P, Holderer-Kottmann U, Zemmler T, Swobodnik W, Ditschuneit H. Visualizing Medical Knowledge. In: Adlassnig KP, Grabner G, Bengtsson S, Hansen R (eds): Medical Informatics Europe 1991. Lecture Notes in Medical Informatics 45, Berlin: Springer, 1991, 634-638. doi: 10.1007/978-3-642-93503-9_113
  71. Kuhn K, Roesner D, Zemmler T, Swobodnik W, Janowitz P, Wechsler JG, Heinlein C, Reichert M, Doster W, Ditschuneit H. A Neural Network Expert System to Support Decisions in Diagnostic Imaging. In: Bankman I.N., Tsitlik J.E. (eds): Proc. 4th Ann. IEEE Symp. Computer-Based Medical Systems. Los Alamitos: IEEE Computer Society Press, 1991, 244-250. doi: 10.1109/CBMS.1991.128974
  72. Kuhn K, Doster W, Roesner D, Kottmann P, Swobodnik W, Ditschuneit H. An Integrated Medical Workstation with a Multimodal User Interface, Knowledge-Based User Support, and Multimedia Documents. In: Proc. 3rd Ann. IEEE Symp. Computer-Based Medical Systems. Los Alamitos: IEEE Computer Society Press, 1990, 469-476. doi: 10.1109/CBMSYS.1990.109435