On May 18th, 1996 I gave a presentation on Diagnostic Decision
Support Systems. The text from the slides follows below.
- basic definitions and concepts
- sense of past and the future
- strengths and limitations
- how to learn more
- updated outline and bibliography
- pointers to related Internet resources
Why is this Important
- John Henry and the Steam Shovel
- extending expertise
- primary care physician
- physician extender
- reducing error (Leape, 1994)
Lessons from Chess
- Garry Kasparov vs. Deep Blue: 3-1-2
- Deep Blue: computational power
- Kasparov: strategy
Definitions - The Descent of Ambition
- Artificial Intelligence: human intelligence, sentience
- Expert System: solve challenging problems, enhance
- Decision Support: anything that supports a decision.
- Diagnostic Decision Support System
- Every time history repeats itself the price goes up.
History -- 1950-69: Great Dreams
- Artificial Intelligence.
- automated ambulatory care
- replacing MDs with paramedical staff and decision aids
History -- 1970-1987: The Age of the Oracle.
- Expert System.
History -- 1988-1996: "The Best of Both Worlds".
- Decision Support
- Narrow domain systems
- Reminders and alerts (active mode)
- Neural networks
- Image processing
Lessons of History: Wetware vs. Hardware
- the human strength: inventing sense and order, flexible
- the machine strength: never forgets, never tires,
- 4th year medical student
- case simulator
- rules and associations
- enhanced textbook
- somewhat useful
- rules and associations
- online to web-based
- server model
Problems with Oracles
- data acquisition
- slow to use
- work flow
- passive mode
- infrequent recognized need
Beyond the Oracles
(1370 citations in current MEDLINE)
- Alerts and Reminders
- hundreds more ...
- problems: publishing, marketing, distribution,
- EKG interpretation
- ABG and lipid interpretations
- PAP smears
- drug-drug interactions
Alerts and Reminders
- out-of-range test flagging
- Rind et al, 1994: effective!
- rising Cr + nephrotoxic meds
- 21.6 hour earlier dosage change
- RR injury .45
- HELP system (LDS)
- static: efficient reference material, index
- dynamic + triggered + embedded resembles expert system
- work flow and performance
- needs assessment
- law and the FDA
- standard ways to represent rules
- electronic medical record
- customized guidelines
- distributed expert systems
- web publication?
Lessons from Chess: Next Year
- Kasparov: one year older
- Deep Blue: ?ten times faster
- Man-machine chess
- reminders work
- narrow-domain systems work
- work-flow integration needs EMR
- we'll be getting smarter ...
Author: John G. Faughnan.
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