Advertisement

Diagnostic Decision Support

  • Mitchell J. Feldman
Part of the Health Informatics book series (HI)

Abstract

In 1763, the Reverend Thomas Bayes published “a method by which we might judge concerning the probability that an event has to happen, in given circumstances, upon supposition that we know nothing concerning it but that, under the same circumstances, it has happened a certain number of times, and failed a certain other number of times.”1 This is Bayes' Law, which in 1959, was applied to medical diagnosis2 to form the basis of diagnostic decision support.3, 4 Because almost all computer-based medical diagnostic decision support systems (MDDSS) use some application of Bayes' Law, it is instructive to review basic principles.

Keywords

Positive Predictive Value Clinical Decision Support System Intended Function Author Disclosure Pediatric Emergency Medicine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bayes T Rev. An Essay towards solving a Problem in the Doctrine of Chances. Philos Trans R Soc Lon. 1763;53:370–418.CrossRefGoogle Scholar
  2. 2.
    Ledley RS, Lusted LB. Reasoning foundations of medical diagnosis. Science. 1959;130:9–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Miller RA. Medical diagnostic decision support systems-past, present, and future: a threaded bibliography and brief commentary. J Am Med Inform Assoc. 1994;1:8–27.PubMedGoogle Scholar
  4. 4.
    Johnson KB, Feldman MJ. Medical informatics and pediatrics. Decision-support systems. Arch Pediatr Adolesc Med. 1995;149(12):1371–1380.PubMedGoogle Scholar
  5. 5.
    Elstein AS, Schwarz A. Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324(7339):729–732.PubMedCrossRefGoogle Scholar
  6. 6.
    Sox HC. The evaluation of diagnostic tests: principles, problems and new developments. Annu Rev Med. 1996;47:463–471.PubMedCrossRefGoogle Scholar
  7. 7.
    World Health Organization. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO; 2008. Available at: http://www.who.int/csr/disease/avian_influenza/country/en/. Accessed December 20, 2008.
  8. 8.
    US Census Bureau. U.S. and World Population Clocks; 2008. Available at: http://www.census.gov/main/www/popclock.html. Accessed December 20, 2008.
  9. 9.
    Wikipedia. Occam's Razor; 2008. Available at: http://en.wikipedia.org/wiki/Occam's_razor. Accessed December 20, 2008.
  10. 10.
    Oski FA, Oski JA. The diagnostic process. In: McMillan J et al., ed. Oski's Pediatrics: Principles & Practice. Philadelphia, PA: Lippincott; 2006:43–44.Google Scholar
  11. 11.
    Ely JW, Osheroff JA, EBell MH, et al. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999;319:358–361.PubMedGoogle Scholar
  12. 12.
    Warner HR et al. A mathematical approach to medical diagnosis. Application to congenital heart disease. JAMA. 1961;177(3):75–81.Google Scholar
  13. 13.
    deDombal F et al. Computer-aided diagnosis of acute abdominal pain. BMJl. 1972;2:9–13.CrossRefGoogle Scholar
  14. 14.
    Miller RA, Pople HE, Myers JD. INTERNIST-1, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med. 1982;307:468–476.PubMedGoogle Scholar
  15. 15.
    Miller RA, Masarie FE Jr. The demise of the ‘Greek Oracle’ model for medical diagnostic systems. Method Inform Med. 1990;29:1–2.Google Scholar
  16. 16.
    Graber ML, Franklin N, Gordon R. Diagnostic error in Internal Medicine. Arch Intern Med. 2005;165:1493–1499.PubMedCrossRefGoogle Scholar
  17. 17.
    Musen MA, Shahar Y, Shortliffe EH. Clinical decision support systems. In: Shortliffe EH et al., ed. Medical Informatics: Computers Applications in Health Care and Biomedicine. New York: Springer; 2001:583.Google Scholar
  18. 18.
    Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain. An evolving diagnostic decision-support system. JAMA. 1987;258(1):67–74.PubMedCrossRefGoogle Scholar
  19. 19.
    National Library of Medicine. PubMed. Available at: http://www.pubmed.gov. Accessed May 29, 2008.
  20. 20.
    Berner ES, Maisiak RS. Physician use of interactive functions in diagnostic decision support systems. AMIA Annu Symp Proc. 1997. Available at: http://www.pubmedcentral.nih.gov/picrender.fcgi?artID=2233322&blobtype=pdf. Accessed December 20, 2008.
  21. 21.
    DXplain; 2008. Available at: http://dxplain.org. Accessed December 20, 2008.
  22. 22.
    Hoffer EP, Feldman MJ, Kim RJ, Famiglietti KT, Barnett GO. DXplain: patterns of use of a mature expert system. AMIA Annu Symp Proc. 2005: 321–325.Google Scholar
  23. 23.
    ePocrates. Epocrates Collaborates with Massachusetts General Hospital to Offer Unique Decision Support Tool; 2006. Available at: http://www.epocrates.com/company/news/10239.html. Accessed December 20, 2008.
  24. 24.
    Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain: experience with knowledge acquisition and program evaluation. Proceedings of the Eleventh Annual Symposium on Computer Applications in Medical Care. New York: IEEE Computer Society Press; 1987:150–154.Google Scholar
  25. 25.
    Feldman M, Barnett GO. Pediatric computer-based diagnostic decision support. Scientific program, Section on Computers and Other Technologies, American Academy of Pediatrics. New Orleans, LA: American Academy of Pediatrics; 1991.Google Scholar
  26. 26.
    Berner ES, Webster GD, Shugerman AA, et al. Performance of four computer-based diagnostic systems. New Engl J Med. 1994;330:1792–1796.PubMedCrossRefGoogle Scholar
  27. 27.
    Bauer BA, Lee M, Bergstrom L, et al. Internal medicine resident satisfaction with a diagnostic decision support system (DXplain) introduced on a teaching hospital service. Proc/AMIA Annu Symp. 2002:31–35.Google Scholar
  28. 28.
    Global Infectious Disease and Epidemiology Network (GIDEON); 2008. Available at: http://www.gideononline.com. Accessed December 20, 2008.
  29. 29.
    Global Infectious Disease and Epidemiology Network. The GIDEON Product: Content, Users, Accuracy, Requirements; 2008. Available at: http://www.gideononline.com/product.htm#Content. Accessed December 20, 2008.
  30. 30.
    Edberg SC. Global infectious diseases and epidemiology network (GIDEON): a world wide Web-based program for diagnosis and informatics in infectious diseases. Clin Infect Dis. 2005;40(1):123–126.PubMedCrossRefGoogle Scholar
  31. 31.
    Berger SA. GIDEON: a computer program for diagnosis, simulation, and informatics in the fields of geographic medicine and emerging diseases. Emerg Infect Dis. 2001; 7(3 Suppl):550.PubMedCrossRefGoogle Scholar
  32. 32.
    Ross JJ, Shapiro DS. Evaluation of the computer program GIDEON (Global Infectious Disease and Epidemiology Network) for the diagnosis of fever in patients admitted to a medical service. Clin Infect Dis. 1998;26(3):766–767.PubMedCrossRefGoogle Scholar
  33. 33.
    Luo RF, Bartlett JG. Use of the computer program GIDEON at an inpatient infectious diseases consultation service. Clin Infect Dis. 2006;42(1):157–158.PubMedCrossRefGoogle Scholar
  34. 34.
    Britto J. ISABEL at the helm. A web-based diagnosis system speeds clinical decisions for pediatric physicians. Health Manag Technol. 2004;25(7):28–29.PubMedGoogle Scholar
  35. 35.
    Ramnarayan P, Tomlinson A, Rao A, Coren M, Winrow A, Britto J. ISABEL: a web-based differential diagnostic aid for paediatrics: results from an initial performance evaluation. Arch Dis Child. 2003;88:408–413.PubMedCrossRefGoogle Scholar
  36. 36.
    Autonomy Corporation. Frequently Asked Questions: What does Autonomy do? at: http://www.autonomy.com/content/Autonomy/FAQ/. Accessed December 20, 2008.
  37. 37.
    Britto J. (2005) Personal CommunicationGoogle Scholar
  38. 38.
    Ramnarayan P, Tomlinson A, Kulkarni G, Rao A, Britto J. (2004) A novel diagnostic aid (ISABEL): development and preliminary evaluation of clinical performance. Medinfo. 2004; 11(pt 2):1091–5.Google Scholar
  39. 39.
    Bavdekar SB. Pawar M. (2005) Evaluation of an Internet delivered pediatric diagnosis support system (ISABEL) in a tertiary care center in India. Indian Pediatrics. 42(11):1086–91.PubMedGoogle Scholar
  40. 40.
    Thomas NJ, Ramnarayan P, Bell MJ et al. (2008) An international assessment of a web-based diagnostic tool in critically ill children. Technology and Health Care. 16:103–110.PubMedGoogle Scholar
  41. 41.
    Friedman CP, Elstein AS, Wolf FM et al. (1999) Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems. JAMA. 282:1851–1856.PubMedCrossRefGoogle Scholar
  42. 42.
    Ramnarayan P, Kapoor RR, Coren M et al. (2003) Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score. Journal of the American Medical Informatics Association 10(6):563–572.PubMedCrossRefGoogle Scholar
  43. 43.
    Liaison Committee on Medical Education. (2008) Functions and Structure of a Medical School, Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. URL: http://www.lcme.org/functions2008jun.pdf [last accessed 20 December 2008].
  44. 44.
    [No authors listed] (1999) Contemporary issues in medicine--medical informatics and population health: report II of the Medical School Objectives Project. Acad Med. 74(2):130–41.Google Scholar
  45. 45.
    Willoughby RE Jr. Tieves KS. Hoffman GM. Ghanayem NS. Amlie-Lefond CM. Schwabe MJ. Chusid MJ. Rupprecht CE. (2005) Survival after treatment of rabies with induction of coma.New England Journal of Medicine. 352(24):2508–14.PubMedCrossRefGoogle Scholar
  46. 46.
    Isabel Healthcare. (2008). Isabel Website. URL: http://www.isabelhealthcare.com [last accessed 20 December 2008].
  47. 47.
    Simon JE. (1992) Computerized diagnostic referencing in pediatric emergency medicine. Pediatr Clin North Am. 39(5):1165–74.PubMedGoogle Scholar
  48. 48.
    Athreya BH, Cheh ML, Kingsland LC 3rd. (1998) Computer-assisted diagnosis of pediatric rheumatic diseases. Pediatrics. 102(4):e48.PubMedCrossRefGoogle Scholar
  49. 49.
    Berman S. (2003) Pediatric Decision Making. 4th ed. Mosby.Google Scholar
  50. 50.
    McDonald CJ. (1976) Protocol-based computer reminders: The quality of care and the nonper-fectability of man. New England Journal of Medicine 295:1351–1355.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Mitchell J. Feldman
    • 1
  1. 1.Department of Medicine and in PediatricsMassachusetts General HospitalBoston

Personalised recommendations