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Computer-assisted medical decision making: A critical review

  • Pulmonary Function Testing and Clinical Decision Making
  • Published:
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Abstract

This paper presents an overview of the concepts underlying computer-assisted medical decision-making (CMD) systems. Alternative approaches to constructing CMD systems are reviewed, including “conventional programming techniques,” statistical pattern classification, rule-based deduction, modelling of diagnostic reasoning, and data base comparisons. Each of these methods is illustrated with examples taken from pulmonary medicine. Although much progress has been made over the last two decades, all existing methods for creating CMD systems are seen to be limited in their ability to represent and process medical knowledge. Other problems facing the field include the time and cost of CMD system development, physician resistance to using these systems, the question of transferability, and the lack of large, reliable data bases for many clinical problems. Recent trends that may overcome these problems are identified and discussed.

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References

  1. Aikins, J. Prototypes and production rules—A knowledge representation for computer consultations. Memo HPP-80-17, Stanford Heuristic Programming Project, 1980.

  2. Alperovitch, A. and J. Lellouch. Methods for aiding medical decision: Application to diagnosis of round intra-thoracic x-ray pictures.Comput. Biomed. Res. 7:127–141, 1974.

    Article  CAS  PubMed  Google Scholar 

  3. American Joint Committee for Cancer Staging and End-Results Reporting.Manual for Staging of Cancer, 1978, pp. 59–64.

  4. Bleich, H. Computer-based consultation.Am. J. Med. 53:285–291, 1972.

    Article  CAS  PubMed  Google Scholar 

  5. Couch, N.N. Tilney, A. Raynor, and F. Moore. The high cost of low-frequency events.N. Engl. J. Med. 304:634–637, 1981.

    CAS  PubMed  Google Scholar 

  6. Croft, D. and R. Machol. Mathematical methods in medical diagnosis.Ann. Biomed. Eng. 2:69–89, 1974.

    CAS  PubMed  Google Scholar 

  7. Davies, P. Symptom diagnosis using Bahadur's distribution.Biomed. Comput. 3:307–312, 1972.

    CAS  Google Scholar 

  8. Duda, R. and P. Hart.Pattern Classification and Scene Analysis. New York: Wiley-Interscience, 1973, pp. 1–262.

    Google Scholar 

  9. Fagan, L., J. Kunz, E. Feigenbaum, and J. Osborn. A symbolic processing approach to measurement interpretation in the intensive care unit. Proceedings of the Third Annual Symposium on Computer Applications in Medical Care, IEEE, 1979, pp. 30–33.

  10. Feinstein, A., J. Rubinstein, and W. Ramshaw. Estimating prognosis with the aid of a conversational-mode computer program.Ann. Intern. Med. 76:911–921, 1972.

    CAS  PubMed  Google Scholar 

  11. Fryback, D. Bayes' theorem and conditional non-independence of data in medical diagnosis.Comput. Biomed. Res. 11:423–434, 1978.

    Article  CAS  PubMed  Google Scholar 

  12. Grimm, R., K. Shimoni, W. Harlan, and E. Estes. Evaluation of patient-care protocol use by various providers.N. Engl. J. Med. 292:507–511, 1975.

    PubMed  Google Scholar 

  13. Hybl, A. and J. Reggia. An educational program in medical computing for clinicians and health scientists. Proceedings of the Second National Educational Computing Conference, Norfolk, Virginia, June 23–25, 1980, pp. 276–280.

  14. Koran, L. The reliability of clinical methods, data and judgementsN. Engl. J. Med. 293:642–701, 1975.

    CAS  PubMed  Google Scholar 

  15. Kunz, J., R. Fallat, D. McClung, J. Osborn, B. Votteri, H. Nii, J. Aikings L. Fagan, and E. Feigenbaum. A physiological rule-based system for interpreting pulmonary function test results. HPP-78-19, Dept. of Computer Science, Stanford University, 1978.

  16. Leaper, D., J. Horrocks, J. Staniland, and F. deDombal. Computer-assisted diagnosis of abdominal pain using estimates provided by clinicians.Br. Med. J. 4:350–354, 1972.

    CAS  PubMed  Google Scholar 

  17. Matthys, H., J. Fischer, H. Ulrichs and K. Ruhle. Functional patterns of different lung diseases for computer-assisted diagnostic procedures.Prog. Respir. Res. 11:188–201, 1979.

    Google Scholar 

  18. Menn, S., G. Barnett, D. Schmechel, W. Owens, and H. Pontoppidan. A computer program to assist in the care of acute respiratory failure.J. Am. Med. Assoc. 233:308–312, 1973.

    Google Scholar 

  19. Minsky, M. A framework for representing knowledge. In:The Psychology of Computer Vision, edited by P. Winston, New York: McGraw-Hill, 1975, pp. 211–277.

    Google Scholar 

  20. Nii, H. and N. Aiello. AGE (attempt to generalize)-A knowledge-based program for building knowledge-based programs. Proceedings of the Sixth International Joint Conference on Artificial Intelligence, 1979, pp. 645–655.

  21. Norusis, M. and J. Jacquez. Diagnostic models based on attribute clusters: A proposal and comparisons.Comput. Biomed. Res. 8:173–188, 1975.

    CAS  PubMed  Google Scholar 

  22. Pimmel, R., M. Tsai, and J. Donohue. Forced expiratory spirometric parameters derived by feature-extraction techniques.Am. Rev. Respir. Dis. 120:1245–1250, 1979.

    CAS  PubMed  Google Scholar 

  23. Pople, H., J. Myers, and R. Miller. DIALOG-A model of diagnostic logic for internal medicine. Proceedings of the Fourth International Joint Conference on Artificial Intelligence. 4:848–855, 1975.

    Google Scholar 

  24. Prutting, J. Lack of correlation between antemortem and postmortem diagnoses.N. Y. State J. Med. 67:2081–2084, 1967.

    CAS  PubMed  Google Scholar 

  25. Reggia, J. A production rule system for neurological localization. Proceedings of the Second Annual symposium on Computer Applications in Medical Care, IEEE, 1978, pp. 254–260.

  26. Reggia, J. A domain-independent system for developing knowledge bases. Proceedings of the Third Biennial Conference of the Canadian Society for Computational Studies of Intelligence, 1980, pp. 289–295.

  27. Reggia, J. Knowledge-based decision support systems—Development through KMS. TR-1121, Department of Computer Science, University of Maryland, 1981.

  28. Richards, B. and A. Goh. Computer assistance in the treatment of patients with acid-base and electrolyte disturbances.Medinfo 77, International Federation of Information Processing, 1977, pp. 407–410.

  29. Robinson, A. Micromainframe is newest computer on a chip.Science 212:527–531, 1981.

    Google Scholar 

  30. Shapiro, A. The evaluation of clinical predictions.N. Engl. J. Med. 296:1509–1514, 1977.

    CAS  PubMed  Google Scholar 

  31. Solberg, H. A computer program for quality control of blood acid/base results.Comput. Programs Biomed. 3:79–86, 1973.

    CAS  PubMed  Google Scholar 

  32. Sox, H.C. and R. Tompkins. The training of physician's assistants-The use of a clinical algorithm system for patient care, audit of performance and education.N. Engl. J. Med. 288:818–824, 1973.

    PubMed  Google Scholar 

  33. Steel, K., P. Gertman, C. Crescenzi, and J. Anderson. Iatrogenic illness on a general medical service at a university hospital.N. Engl. J. Med. 304:638–642, 1981.

    CAS  PubMed  Google Scholar 

  34. Taylor, T. Clinical decision analysis.Methods Inf. Med. 15:216–224, 1976.

    CAS  PubMed  Google Scholar 

  35. Templeton, A., C. Jansen, J. Lehr, and R. Hufft. Solitary pulmonary lesions: Computer-aided differential diagnosis and evaluation of mathematical methods.Radiology 89:605–613, 1967.

    CAS  PubMed  Google Scholar 

  36. Tsai, M., R. Pimmel, and J. Donohue. Automatic classification of spirometric data.IEEE Trans. Biomed. Eng. 26:293–298, 1979.

    CAS  PubMed  Google Scholar 

  37. Tversky, A. Assessing uncertainty.J. Roy. Sta. Soc. B. 36:148–159, 1974.

    Google Scholar 

  38. van Meerten, R. J. Durinck and C. DeWit. Computer guided diagnosis of asthma, asthmatic bronchitis, chronic bronchitis and emphysema.Respiration 28:293–305 and 399–408, 1971.

    PubMed  Google Scholar 

  39. Waterman, D. and F. Hayes-Roth. An overview of pattern-directed inference systems. In:Pattern-Directed Inference Systems, edited by D. Waterman, and F. Hayes-Roth. New York: Academic Press, 1978, pp. 3–22.

    Google Scholar 

  40. Wechsler, H. A fuzzy approach to medical diagnosis.Int. J. Biomed. Comput. 7:191–203, 1976.

    Article  CAS  PubMed  Google Scholar 

  41. Zagoria, R., J. Reggia, T. Price, and M. Banko. Bayesian classification in medicine: The transferability question. Proceedings of the Fifth Annual Symposium on Computer Applications in Medical Care, 1981, pp. 250–252.

  42. Zoltie, N., J. Horrocks, and F. deDombal. Computer-assisted diagnosis of dyspepsia—Report on transferability of a system, with emphasis on early diagnosis of gastric cancer.Methods Inf. Med. 16:89–92, 1977.

    CAS  PubMed  Google Scholar 

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  1. University of Maryland, Baltimore, Maryland

    James A. Reggia

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Reggia, J.A. Computer-assisted medical decision making: A critical review. Ann Biomed Eng 9, 605–619 (1981). https://doi.org/10.1007/BF02364774

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