%X Relevant literature has been reviewed regarding the
performance, implementation and evaluation of computer
based medical decision support systems.
The diagnostic performance of five simple case driven
acute chest pain advice systems, have been compared
using a standardized set of clinical records. A
Bayesian inference model demonstrated superiority over
two derived by logistic regression. Small data set
flow charts performed well but both relied upon the
use of expert opinion.
A Bayesian acute abdominal pain diagnostic advice
system has been evaluated in a clinical trial.
Standardized data collection improved the diagnostic
performance of doctors. In practice, the computer
system offered little additional user benefit. From
further tests in primary care, it was concluded that,
whereas general practitioners might enhance their
performance by using data collection sheets,
paramedics might benefit through direct use of the
computer.
DERMIS is a new dermatology primary care diagnostic
advice system. Components include a database derived
from 5203 prospectively collected clinical records, a
user interface, and an enhanced Bayesian inference
model incorporating combined frequency estimates,
expert beliefs and rationalized end-point groups. On
laboratory testing, the diagnostic accuracy of DERMIS
was 83%. The correct diagnosis appeared in the top
three, of a possible 42 disease list on 97% of
occasions.
In a semi-field trial of DERMIS involving 49 general
practitioners, doctors did not always collect the same
information as a dermatologist but were able to
significantly increase their chance of making a
correct diagnosis through use of the computer system.
It has been concluded that although implementation of
DERMIS might well increase general practitioner
diagnostic accuracy and lead to improvements in the
management of skin disease in primary care, rates of
referral for specialist opinion might not be affected
unless standard management plans are adopted.
%T The evaluation and enhancement of case driven diagnostic advice systems: a study in three domains
%O Thesis digitised by British Library EThOS
%A G.J. Brooks
%D 1993
%L discovery1317709
%I University of London