A fuzzy approach to medical diagnosis

Computer-based clinical decision aids. A review of methods and assessment of systems

During the last three decades a great deal of research has been devoted to the development of integrated clinical decision support systems. This report aims to give a basic understanding of what is required for such a system. By means of a large literature study a survey is given of the major components of computer-based clinical aid systems. The main approaches and several aspects of evaluation of such programs are described. The computer has several inherent capabilities which are suitable for medical problem solving and can help in the formalization of medical knowledge. The components of such systems include the computer database, the reasoning engine and the user interface. The different approaches on which the reasoning engine is built are based on manipulation of information and advocate the use of knowledge to construct a solution to a problem. The information in the mode vary from data-intensive to knowledge-intensive. Assessment of decision support systems is a very important phase in the development of such systems. Evaluation should be made on the accuracy of the program, the nature of the system, the use of the data and the acceptance by the target users. Whatever the model is, its effectiveness will depend on the data with which the program has to work. Acceptance by physicians depends among other things on ease of use of the user interface. Profound changes in the delivery of health care will be induced through the rapid growth of on-line computer communication together with the development of integrated clinical decision support systems and electronic medical records. Notwithstanding the rapid growth of computer technology, computer-aided decision making is in its infancy and real support in daily practice is not yet achieved.

A survey of decision aids for clinicians

Inconsistency in applying medical knowledge is a major reason for varying standards of medical care. Five types of aid have been introduced into medicine to help decision-making: questionnaires, algorithms, database systems, diagnostic systems, and, finally, computer-based decision-support systems. Of these, the most effective act as reminder or prompt systems to assist doctors without threatening their clinical freedom.

A method for the quantification of the decision-making process in a computer-oriented medical world

The aim of this paper is to suggest an original approach to the decision-making process in a computer-oriented medical record, now in use on an experimental basis, at a major District Hospital in Sesto S. Giovanni, near Milano, in a general medicine department. Two types of algorithms are introduced in order to 'capture' more effectively the different steps of the decisional process on the basis of a differential diagnosis approach. The first refers to the field of symbolic reasoning, close to the area of Artificial Intelligence and uses score variables, while the other can handle qualitative expressions since it follows the fuzzy-set approach. A comparison among the performances offered by such algorithms, the physician's decision and the Bayes Rule is then carried on. Further developments should clarify the problems of parameter sensitivity as regards the successive steps to the final diagnosis. The present implementation is suitable for individual hospital departments and educational purposes.

Computer-based interpretation of clinical laboratory tests

A system has been developed for the interpretation of laboratory findings which can aid in medical diagnosis as well as monitoring medical treatment. Tools are provided for defining, updating and verifying rules for the interpretation of laboratory tests in a computer-acceptable form. The present system uses a set of arithmetic logic rules which allows comprehensive evaluation of laboratory data as well as bringing into focus fluctuating and borderline situations and inconclusive data. Application of the system for over a year has shown that it is easy to use by laboratory staff with no knowledge of programming. Moreover, it has forced greater comprehensiveness, objectivity, consistency and speed in the interpretation of laboratory results than is generally achieved by standard practice.

Some observations on fuzzy diagnosis and medical computing

Wechsler has advocated the use of fuzzy logic for medical diagnosis, but it is pointed out that simpler systems have proved more successful than is apparent from his paper. The proposal raises a broad range of issues concerning the role of sophisticated information-processing techniques in the development of medical computing. These issues are discussed and it is suggested that a more evolutionary view of this development would be of greater benefit in the long run.