Skip to main content
SpringerLink
Log in

Clinical Diagnostic Decision Support Systems—An Overview

  • Chapter
Book cover Clinical Decision Support Systems

Part of the book series: Health Informatics ((HI))

Abstract

Since primeval times, mankind has attempted to explain natural phenomena using models. For the past four decades a new kind of modeler, the health care informatician, has developed and proliferated a new kind of model, the Clinical Diagnostic Decision Support System (CDDSS). Modeling historically was, and still remains, an inexact science. Ptolemy, in the ‘Almagest’, placed the earth at the center of the universe, and could still explain why the sun would rise in the east each morning. Newton’s nonrelativistic formulation of the laws of mechanics work well for earth-bound engineering applications. Past and present CDDSS incorporate inexact models of the incompletely understood and exceptionally complex process of clinical diagnosis. Yet mankind, using imperfect models, has built machines that fly and has cured many diseases. Because CDDSS augment the natural capabilities of human diagnosticians, it is likely they will be employed productively.1

Portions of this chapter have been taken verbatim, with permission of the American Medical Informatics Association (AMIA), which owns the copyrights, from: Miller RA. Medical Diagnostic Decision Support Systems—Past, Present, and Future: A Threaded Bibliography and Commentary JAMIA 1994; 1:8–27, and from Miller RA. Evaluating Evaluations of Medical Diagnostic Systems, JAMIA 1996; 3:429–431.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Miller RA. Medical diagnostic decision support systems—past, present, and future: a threaded bibliography and commentary. JAMIA 1994; 1:8–27.

    Article  PubMed  CAS  Google Scholar 

  2. Miller RA. Why the standard view is standard: people, not machines, understand patients’ problems. J Med Philos 1990; 15:581–591.

    Article  PubMed  CAS  Google Scholar 

  3. Flexner SB, Stein J, eds. The Random House College Dictionary, Revised Edition. New York: Random House, Inc., 1988,366.

    Google Scholar 

  4. Osheroff JA, Forsythe DE, Buchanan BG et al. Physicians’ information needs: an analysis of questions posed during clinical teaching in internal medicine. Ann Intern Med 1991; 114:576–581.

    Article  PubMed  CAS  Google Scholar 

  5. Forsythe DE, Buchanan BG, Osheroff JA et al. Expanding the concept of medical information: an observational study of physicians’ information needs. Comput Biomed Res 1992; 25:181–200.

    Article  PubMed  CAS  Google Scholar 

  6. Miller R, Masarie FE, Myers J. Quick Medical Reference (QMR) for diagnostic assistance. MD Comput 1986; 3:34–48.

    PubMed  CAS  Google Scholar 

  7. Miller RA, Masarie FE Jr. The quick medical reference (QMR) relationships function: description and evaluation of a simple, efficient “multiple diagnoses” algorithm. Medinfo 1992:512–518.

    Google Scholar 

  8. Miller RA, Masarie FE Jr. The demise of the “Greek Oracle” model for medical diagnosis systems. Methods Inf Med 1990; 29:1–2.

    PubMed  CAS  Google Scholar 

  9. de Dombal FT, Leaper DJ, Horrocks JC et al. Human and computer-aided diagnosis of abdominal pain: further report with emphasis on performance of clinicians. Br Med J 1974; 1:376–380.

    Article  PubMed  Google Scholar 

  10. Adams ID, Chan M, Clifford PC et al. Computer aided diagnosis of acute abdominal pain: a multicentre study. Br Med J (Clin Res Ed) 1986; 293:800–804.

    Article  CAS  Google Scholar 

  11. Rosenbaum M, Leibel RL, Hirsch J. Obesity. N Engl J Med 1997; 337:396–407.

    Article  PubMed  CAS  Google Scholar 

  12. Newell A, Simon HA. Human Problem Solving. Englewood Cliffs, NJ: Prentice Hall, 1972.

    Google Scholar 

  13. Kahneman D, Slovic P, Tversky A, eds. Judgment Under Uncertainty: Heuristics and Biases. Cambridge, UK: Cambridge University Press, 1982.

    Google Scholar 

  14. Elstein AS, Shulman LS, Sprafka SA. Medical problem solving: an analysis of clinical reasoning. Cambridge, MA: Harvard University Press, 1978.

    Google Scholar 

  15. Kassirer JP, Gorry GA. Clinical problem-solving—a behavioral analysis. Ann Intern Med 1978; 89:245–255.

    Article  PubMed  CAS  Google Scholar 

  16. Miller GA. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev 1956; 63:81–97.

    Article  PubMed  CAS  Google Scholar 

  17. Evans DA, Patel VL, eds. Cognitive Science in Medicine. Cambridge, MA: MIT Press, 1989.

    Google Scholar 

  18. Pople HE Jr. Heuristic methods for imposing structure on ill-structured problems: the structuring of medical diagnostics. In Szolovits P, ed. Artificial Intelligence in Medicine. AAAS Symposium Series. Boulder, CO: Westview Press. 1982, 119–190.

    Google Scholar 

  19. Simon HA. The structure of ill-structured problems. Artif Intell 1973; 4:181–201.

    Article  Google Scholar 

  20. Miller RA, Pople HE Jr, Myers J. Internist-I, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307:468–476.

    Article  PubMed  CAS  Google Scholar 

  21. Eddy DM, Clanton CH. The art of diagnosis: solving the clinicopatho-logical conference. N Engl J Med 1982; 306:1263–1269.

    Article  PubMed  CAS  Google Scholar 

  22. Weed LL. Medical records that guide and teach. N Engl J Med 1968; 278:593–600 and 652–657.

    Article  PubMed  CAS  Google Scholar 

  23. Hurst JW, Walker HK, eds. The Problem-Oriented System. New York, NY: Medcom Learning Systems, 1972.

    Google Scholar 

  24. Kassirer JP. Diagnostic reasoning. Ann Intern Med 1989; 110:893–900.

    Article  PubMed  CAS  Google Scholar 

  25. Brunswik E. Representative design and probabilistic theory in a functional psychology. Psychol Rev 1955; 62:193–217.

    Article  PubMed  CAS  Google Scholar 

  26. Ledley RS, Lusted LB. Reasoning foundations of medical diagnosis. Science 1959; 130:9–21.

    Article  PubMed  CAS  Google Scholar 

  27. Warner HR, Toronto AF, Veasey LG et al. Mathematical approach to medical diagnosis. JAMA 1961; 177:75–81.

    Article  Google Scholar 

  28. Raiffa H. Decision analysis. Reading, MA: Addison-Wesley Inc. 1970.

    Google Scholar 

  29. Pauker SG, Kassirer JP. Decision analysis. N Engl J Med 1987; 316:250–258.

    Article  PubMed  CAS  Google Scholar 

  30. Dawes RM, Faust D, Meehl PE. Clinical versus actuarial judgment. Science 1989; 243:1668–1674.

    Article  PubMed  CAS  Google Scholar 

  31. Gigerenzer G, Hoffrage U. How to improve Bayesian reasoning without instruction: frequency formats. Psychol Rev 1995; 102:684–704.

    Article  Google Scholar 

  32. Feinstein AR. An analysis of diagnostic reasoning. I. The domains and disorders of clinical macrobiology. Yale J Biol Med 1973; 46:212–232.

    PubMed  CAS  Google Scholar 

  33. Feinstein AR. An analysis of diagnostic reasoning. II. The strategy of intermediate decisions. Yale J Biol Med 1973; 46:264–283.

    PubMed  CAS  Google Scholar 

  34. Horvitz EJ, Heckerman DE. The inconsistent use of measures of certainty in artificial intelligence research. In: Uncertainty in Artificial Intelligence, Vol 1. Amsterdam; New York: Elsevier Science, 1986, 137–151.

    Google Scholar 

  35. Blois MS. Clinical judgment and computers. N Engl J Med 1980; 303:192–197.

    Article  PubMed  CAS  Google Scholar 

  36. Shortliffe EH, Buchanan BG, Feigenbaum EA. Knowledge engineering for medical decision-making: a review of computer-based clinical decision aids. Proc IEEE 1979; 67:1207–1224.

    Article  Google Scholar 

  37. Willems JL, Abreu-Lima C, Arnaud P et al. The diagnostic performance of computer programs for the interpretation of electrocardiograms. N Engl J Med 1991; 325:1767–1773.

    Article  PubMed  CAS  Google Scholar 

  38. Bleich HL. Computer evaluation of acid-base disorders. J Clin Invest 1969; 48:1689–1696.

    Article  PubMed  CAS  Google Scholar 

  39. Gorry GA, Barnett GO. Experience with a model of sequential diagnosis. Comput Biomed Res 1968; 1:490–507.

    Article  PubMed  CAS  Google Scholar 

  40. Szolovits P, Pauker SG. Categorical and probabilistic reasoning in medical diagnosis. Artif Intell 1978; 11:114–144.

    Article  Google Scholar 

  41. Lipkin M, Hardy JD. Differential diagnosis of hematological diseases aided by mechanical correlation of data. Science 1957; 125:551–552.

    Article  PubMed  CAS  Google Scholar 

  42. Lipkin M, Hardy JD. Mechanical correlation of data in differential diagnosis of hematological diseases. JAMA 1958; 166:113–123.

    Article  CAS  Google Scholar 

  43. Lipkin M, Engle Jr RL, Davis BJ et al. Digital computer as an aid to differential diagnosis. Arch Intern Med 1961; 108:124–140.

    Article  Google Scholar 

  44. Lindberg DAB, Rowland LR, Buch CR Jr et al. CONSIDER: A computer program for medical instruction. Proc Ninth IBM Medical Symposium, 1968.

    Google Scholar 

  45. Nelson SJ, Blois MS, Tuttle MS et al. Evaluating RECONSIDER: a computer program for diagnostic prompting. J Med Sys 1985; 9:379–388.

    Article  CAS  Google Scholar 

  46. Weiss S, Kulikowski CA. EXPERT: a system for developing consultation models. Proc Sixth Int Joint Conf Artif Intell 1979.

    Google Scholar 

  47. Lindberg DAB, Sharp GC, Kingsland LC et al. Computer based Rheumatology consultant. Medinfo 1980:1311–1315.

    Google Scholar 

  48. Moens HJ, van der Korst JK. Development and validation of a computer program using Bayes’s theorem to support diagnosis of rheumatic disorders. Ann Rheum Dis 1992; 51:266–271.

    Article  PubMed  CAS  Google Scholar 

  49. Gorry A. Strategies for computer-aided diagnosis. Math Biosci 1968; 2:293–318.

    Article  Google Scholar 

  50. Pauker SG, Gorry GA, Kassirer JP et al. Towards the simulation of clinical cognition. Taking a present illness by computer. Am J Med 1976; 60:981–996.

    Article  PubMed  CAS  Google Scholar 

  51. Waxman HS, Worley WE. Computer-assisted adult medical diagnosis: subject review and evaluation of a new microcomputer-based system. Medicine 1990; 69:125–136.

    Article  PubMed  CAS  Google Scholar 

  52. Pople HE, Myers JD, Miller RA. DIALOG: A model of diagnostic logic for internal medicine. Proc Fourth Int Joint Conf Artif Intell 1975:848–855.

    Google Scholar 

  53. First MB, Soffer LJ, Miller RA. QUICK (Quick Index to Caduceus Knowledge): Using the Internist-I/Caduceus knowledge base as an electronic textbook of medicine. Comput Biomed Res 1985; 18: 137–165.

    Article  PubMed  CAS  Google Scholar 

  54. Miller RA, McNeil MA, Challinor S et al. Status Report: The Internist-1 / Quick Medical Reference project. West J Med 1986; 145:816–822.

    PubMed  CAS  Google Scholar 

  55. Hupp JA, Cimino JJ, Hoffer EF et al. DXplain—A computer-based diagnostic knowledge base. Medinfo 1986; 5:117–121.

    Google Scholar 

  56. Warner HR, Haug P, Bouhaddou O et al. ILIAD as an expert consultant to teach differential diagnosis. Proc Annu Symp Comput Appi Med Care 1987:371–376.

    Google Scholar 

  57. Shortliffe EH. Computer-Based Medical Consultations: MYCIN. New York, NY: Elsevier Computer Science Library, Artificial Intelligence Series, 1976.

    Google Scholar 

  58. Miller PL. A Critiquing Approach to Expert Computer Advice: ATTENDING. Boston: Pittman, 1984.

    Google Scholar 

  59. Aliferis CF, Miller RA. On the heuristic nature of medical decision-support systems. Methods Inf Med 1995; 34: 5–14.

    PubMed  CAS  Google Scholar 

  60. Reggia JA, Nau DS, Wang PY. Diagnostic expert systems based on a set covering model. Internat J Man-Machine Stud 1983; 19:437–460.

    Article  Google Scholar 

  61. Berman L, Miller RA. Problem area formation as an element of computer aided diagnosis: a comparison of two strategies within quick medical reference (QMR). Methods Inf Med 1991; 30:90–95.

    PubMed  CAS  Google Scholar 

  62. Stead WW et al. Designing medical informatics research and library-resource projects to increase what is learned. JAMIA 1994; 1:28–34.

    Article  PubMed  CAS  Google Scholar 

  63. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Int Med 1985; 103:596–599.

    Article  PubMed  CAS  Google Scholar 

  64. Miller RA. Evaluating evaluations of medical diagnostic systems. JAMIA 1996; 3:429–431.

    Article  PubMed  CAS  Google Scholar 

  65. Yu VL. Conceptual obstacles in computerized medical diagnosis. J Med Phil 1983; 8:67–75.

    Article  CAS  Google Scholar 

  66. Weiss S, Kulikowski CA, Safir A. Glaucoma consultation by computer. Comput Biol Med 1978; 8:24–40.

    Article  Google Scholar 

  67. Giuse NB, Giuse DA, Miller RA et al. Evaluating consensus among physicians in medical knowledge base construction. Methods Inf Med 1993; 32:137–145.

    PubMed  CAS  Google Scholar 

  68. Yu VL, Fagan LM, Wraith SM et al. Antimicrobial selection by computer: a blinded evaluation by infectious disease experts. JAMA 1979; 242:1279–1282.

    Article  PubMed  CAS  Google Scholar 

  69. Mazoue JG. Diagnosis without doctors. J Med Philos 1990; 15: 559–579.

    Article  PubMed  CAS  Google Scholar 

  70. Berner ES, Webster GD, Shugerman AA et al. Performance of four computer-based diagnostic systems. N Engl J Med 1994; 330: 1792–1796.

    Article  PubMed  CAS  Google Scholar 

  71. Lindberg DA, Humphreys BL, McCray AT. The Unified Medical Language System. Methods Inf Med 1993; 32:281–291.

    PubMed  CAS  Google Scholar 

  72. Young FE. Validation of medical software: present policy of the Food and Drug Administration. Ann Intern Med 1987; 106:628–629.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Randolph A. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antoine Geissbuhler
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Informatics Program, Department of Health Services Administration, School of Health Related Professions, 1675 University Boulevard, Room 544, Birmingham, AL, 35294-8219, USA

    Eta S. Berner EdD (Professor, Masters of Science in Health) (Professor, Masters of Science in Health)

  2. Section of Medical Informatics, Division of General Medicine, Department of Medicine, School of Medicine, University of Alabama, 1675 University Boulevard, Room 544, Birmingham, AL, 35294-8219, USA

    Eta S. Berner EdD (Professor, Masters of Science in Health) (Professor, Masters of Science in Health)

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Miller, R.A., Geissbuhler, A. (1999). Clinical Diagnostic Decision Support Systems—An Overview. In: Berner, E.S. (eds) Clinical Decision Support Systems. Health Informatics. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3903-9_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-3903-9_1

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-3905-3

  • Online ISBN: 978-1-4757-3903-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation