Computer-assisted diagnosis of rheumatic disorders.

A review of the literature regarding computer-assisted diagnosis of rheumatic diseases is presented. After a general outline of the history and goals of computer programs intended to support physicians in the diagnostic process, 14 systems or projects are described. The scope of seven of these is general internal medicine, and the other seven are intended exclusively for rheumatic problems. The majority of these systems are prototypes. To date, none of them is widely used by physicians. Preliminary evaluation studies and/or independent reviews have been reported for all of the systems. The need for further evaluation studies is recognized, and strategies to carry these out are outlined. Furthermore, the potential usefulness for patient care and education is discussed. It is concluded that a new and interesting field is being developed that deserves more attention among rheumatologists.

[1]  Peter Szolovits,et al.  Artificial intelligence in medical diagnosis. , 1988, Annals of internal medicine.

[2]  Jeffrey R. Hammersley,et al.  Evaluating the Utility of Available Differential Diagnosis Systems. , 1988 .

[3]  Perry L. Miller.  The evaluation of artificial intelligence systems in medicine. , 1985 .

[4]  van Bemmel Jh,et al.  Formalization of medical knowledge. , 1986 .

[5]  D McSherry,et al.  Knowledge acquisition in the development of an introductory guide to diagnosis in rheumatology. , 1985, Medical informatics = Medecine et informatique.

[6]  P H de Vries,et al.  An Overview of Medical Expert Systems , 1985, Methods of Information in Medicine.

[7]  J. Michaelis,et al.  Evaluation of ECG Interpretation Results Obtained by Computer and Cardiologists , 1990, Methods of Information in Medicine.

[8]  H R Warner.  Iliad: moving medical decision-making into new frontiers. , 1989, Methods of information in medicine.

[9]  D A Lindberg,et al.  Anatomy of a knowledge-based consultant system: AI/RHEUM. , 1986, M.D. computing : computers in medical practice.

[10]  Werner Horn.  Diagnostic Decision Support Based on Generic Disease Descriptions and Detailed Anatomical Knowledge , 1989, AIME.

[11]  R. Miller,et al.  Use of the Quick Medical Reference (QMR) Program as a Tool for Medical Education , 1989, Methods of Information in Medicine.

[12]  Werner Horn,et al.  Utilizing detailed anatomical knowledge for hypothesis formation and hypothesis testing in rheumatological decision support , 1991, Artif. Intell. Medicine.

[13]  J P Kassirer,et al.  Our stubborn quest for diagnostic certainty. A cause of excessive testing. , 1989, The New England journal of medicine.

[14]  Stefan Schewe,et al.  Patient's and Physician's Opinion about Computer Expert Systems , 1991, AIME.

[15]  J. Lei.  Critiquing based on computer-stored medical records , 1991 .

[16]  BRUCE MATHEW MB,et al.  Artificial Intelligence in the Diagnosis of Low‐Back Pain and Sciatica , 1988, Spine.

[17]  Spiegelhalter Dj.  Statistical methodology for evaluating gastrointestinal symptoms. , 1985 .

[18]  M. Khan,et al.  Diagnostic value of HLA-B27 testing ankylosing spondylitis and Reiter's syndrome. , 1982, Annals of internal medicine.

[19]  G. Barnett.  The computer and clinical judgement. , 1982, The New England journal of medicine.

[20]  M. S. Blois.  Clinical judgment and computers. , 1980, The New England journal of medicine.

[21]  K. Adlassnig,et al.  CADIAG: approaches to computer-assisted medical diagnosis. , 1985, Computers in biology and medicine.

[22]  H. Waxman,et al.  Computer‐Assisted Adult Medical Diagnosis: Subject Review and Evaluation of a New Microcomputer‐Based System , 1990, Medicine.

[23]  Lawrence C. Kingsland,et al.  The Evaluation of Medical Expert Systems: Experience with the AI/RHEUM Knowledge-Based Consultant System in Rheumatology , 1988 .

[24]  G. Barnett,et al.  DXplain. An evolving diagnostic decision-support system. , 1987, JAMA.

[25]  J. Rethans,et al.  Do personal computers make doctors less personal? , 1988, British medical journal.

[26]  J. Kassirer,et al.  Decision analysis: a progress report. , 1987, Annals of internal medicine.

[27]  James A. Reggia,et al.  An Overview of Methods for Computer-Assisted Medical Decision Making , 1985 .

[28]  A. Dannenberg,et al.  Enhancement of Clinical Predictive Ability by Computer Consultation) , 1979, Methods of Information in Medicine.

[29]  Peter J. Haug,et al.  ILIAD as an Expert Consultant to Teach Differential Diagnosis , 1988 .

[30]  B Bergeron.  Iliad: a diagnostic consultant and patient simulator. , 1991, M.D. computing : computers in medical practice.

[31]  F E Young,et al.  Validation of medical software: present policy of the Food and Drug Administration. , 1987, Annals of internal medicine.

[32]  J H van Bemmel,et al.  Standardization and Validation of Medical Decision-Support Systems: The CSE Project , 1990, Methods of Information in Medicine.

[33]  L. Kingsland,et al.  The AI/RHEUM knowledge-based computer consultant system in rheumatology. Performance in the diagnosis of 59 connective tissue disease patients from Japan. , 1988, Arthritis and rheumatism.

[34]  Klaus-Peter Adlassnig,et al.  Problems in establishing the medical expert systems CADIAG-1 and CADIAG-2 in rheumatology , 2004, Journal of Medical Systems.

[35]  D W Young.  Computers in Medicine: A survey of decision aids for clinicians , 1982 .

[36]  K. Adlassnig,et al.  Representation and semiautomatic acquisition of medical knowledge in CADIAG-1 and CADIAG-2. , 1986, Computers and biomedical research, an international journal.

[37]  D. Spiegelhalter,et al.  Evaluating medical expert systems: what to test and how? , 1990, Medical informatics = Medecine et informatique.

[38]  H. J. Moens,et al.  Comparison of rheumatological diagnoses by a Bayesian program and by physicians. , 1991 .

[39]  Hein J. Bernelot Moens,et al.  Measuring performance of a Bayesian decision support system for the diagnosis of rheumatic disorders , 1991, AIME.

[40]  E H Shortliffe,et al.  Testing Reality: The Introduction of Decision-Support Technologies for Physicians , 1989, Methods of Information in Medicine.

[41]  James J. Cimino,et al.  DXplain: Experience with Knowledge Acquisition and Program Evaluation. , 1987 .

[42]  H. E. Pople,et al.  Internist-I, an Experimental Computer-Based Diagnostic Consultant for General Internal Medicine , 1982 .

[43]  T R Walsh,et al.  Computer-assisted Bayesian diagnosis of connective tissue diseases. , 1981, Methods of information in medicine.

[44]  H P Lundsgaarde,et al.  Evaluating medical expert systems. , 1987, Social science & medicine.

[45]  W. Scherrmann,et al.  Evaluation and Measuring of Benefit of an Expert System for Differential Diagnosis in Rheumatology , 1988 .

[46]  Gio Wiederhold,et al.  Book III: Scientific and Research Applications in Medical Care: Studying Hypotheses on a Time-Oriented Clinical Database: An Overview of the RX Project , 1982 .

[47]  S G Pauker,et al.  Clinical decision consultation service. , 1986, The American journal of medicine.

[48]  Sholom M. Weiss,et al.  Models for measuring performance of medical expert systems , 1989, Artif. Intell. Medicine.

[49]  Casimir A. Kulikowski,et al.  The expert consultant as teacher , 1983 .

[50]  W. Kapoor,et al.  A computer-assisted medical diagnostic consultation service. Implementation and prospective evaluation of a prototype. , 1989, Annals of internal medicine.

[51]  Stuart J. Nelson,et al.  Making the most of reconsider: an evaluation of input strategies , 1983 .

[52]  Herbert S. Waxman,et al.  Meditel: Computer Assisted Diagnosis.: Version 1.0. , 1990 .

[53]  P. Brooks,et al.  A controlled evaluation of diagnostic criteria in the development of a rheumatology expert system. , 1989, British journal of rheumatology.

[54]  Werner Horn.  MESICAR - A medical expert system integrating causal and associative reasoning , 1989, Appl. Artif. Intell..

[55]  K. Adlassnig,et al.  Present State of the Medical Expert System CADIAG-2 , 1985, Methods of Information in Medicine.

[56]  A. Elstein,et al.  Laboratory Use , 1988, Medical decision making.

[57]  J F Fries,et al.  Time-oriented patient records and a computer databank. , 1972, JAMA.

[58]  R A Miller,et al.  Effect of a Computer-Assisted General Medicine Diagnostic Consultation Service on Housestaff Diagnostic Strategy , 1989, Methods of Information in Medicine.

[59]  Peter J. Haug,et al.  Clustered Knowledge Representation: Increasing the Reliability of Computerized Expert Systems , 1988 .

[60]  E. Shortliffe.  Computer programs to support clinical decision making. , 1990, JAMA.

[61]  Randolph A. Miller,et al.  User Variability in Abstracting and Entering Printed Case Histories with QUICK MEDICAL REFERENCE (QMR). , 1987 .

[62]  J F Fries,et al.  Estimating prognosis in systemic lupus erythematosus. , 1974, The American journal of medicine.