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July 3, 1987, Vol 258, No. 1 >
ARTICLE | July 3, 1987

Computer Programs to Support Clinical Decision Making FREE

Edward H. Shortliffe, MD, PhD
[+] Author Affiliations

Reprint requests to the Stanford University Medical Center, Room MSOB X-215, Departments of Medicine and Computer Science, Stanford, CA 94305-5479 (Dr Shortliffe).


JAMA. 1987;258(1):61-66. doi:10.1001/jama.1987.03400010065029
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References

Computer programs to assist with medical decision making have long been anticipated by physicians with both curiosity and concern. This article summarizes the current status of computer-based medical decision support, the goals of system developers, the reasons for slow progress since the field began almost 30 years ago, and the logistical and scientific challenges that lie ahead. It emphasizes in particular that decision-support programs are intended to serve as tools for trained practitioners who retain ultimate responsibility for determining diagnostic and therapeutic strategies.

(JAMA 1987;258:61-66)

REFERENCES

1 +
Lindberg DAB, Schoolman HM:  The National Library of Medicine and medical informatics . West J Med 1986;;145:786-790.
2 +
Collen MF:  Full-text medical literature retrieval by computer: A pilot test . JAMA 1985;;254:2768-2774.
3 +
Greenes RA:  Knowledge management as an aid to medical decision making and education: The EXPLORER-1 system , in Proceedings of MEDINFO-86. Amsterdam, North Holland, 1986 , pp 895-899.
4 +
Tatro DS, Briggs RL, Chavez-Pardo R, et al:  Online drug interaction surveillance . Am J Hosp Pharm 1975;;32:417-420.
5 +
Blois MS, Tuttle MS, Sheretz DD:  RECONSIDER: A program for generating differential diagnoses , in Proceedings of the Fifth Symposium on Computer Applications in Medical Care . Washington, DC, IEEE Computer Society Press, 1981;, pp 263-268.
6 +
Barnett GO, Cimino JJ, Hupp JA, et al:  DXplain: An evolving diagnostic decision-support system . JAMA 1987;;258:67-74.
7 +
Miller RA, Pople HE Jr, Myers JD:  Internist-1: An evolving computer-based diagnostic consultant for general internal medicine . N Engl J Med 1982;;307:468-476.
8 +
Miller RA, McNeil MA, Challinor SM, et al:  The Internist-1/Quick Medical Reference Project: Status report . West J Med 1986;;145:816-822.
9 +
Ledley RS, Lusted LB:  Reasoning foundations of medical diagnosis . Science 1959;;130:9-21.
10 +
Warner HR, Toronto AF, Veasy LG:  Experience with Bayes' theorem for computer diagnosis of congenital heart disease . Ann NY Acad Sci 1964;; 115:2-16.
11 +
Medical Education in the Information Age (Proceedings of a Symposium on Medical Informatics) . Washington, DC, Association of American Medical Colleges, 1986;.
12 +
Reggia JA, Tuhrim S (eds): Computer-Assisted Medical Decision Making . New York, Springer-Verlag NY Inc, 1985;.
13 +
Warner HR: Computer-Assisted Medical Decision Making . New York, Academic Press Inc, 1978;.
14 +
Pryor RA, Garner RM, Clayton PD, et al:  The HELP System . J Med Syst 1983;;7:87-102.
15 +
McDonald CJ, Hui SL, Smith DM, et al:  Reminders to physicians from an introspective computer medical record . Ann Intern Med 1984;;100: 130-138.
16 +
Reggia JR, Tabb OR, Price TR, et al:  Computer-aided assessment of transient ischemic attacks . Arch Neurol 1984;;41:1248-1254.
17 +
Miller PL: Expert Critiquing Systems: Practice-Based Medical Consultation by Computer . New York, Springer-Verlag NY Inc, 1986;.
18 +
Evans RS, Larsen RA, Burke JP, et al:  Computer surveillance of hospital-acquired infections and antibiotic use . JAMA 1986;;256:1007-1011.
19 +
Hickam DH, Shortliffe EH, Bischoff MB, et al:  The treatment advice of a computer-based cancer chemotherapy protocol advisor . Ann Intern Med 1985;;103:928-936.
20 +
Shortliffe EH:  Medical expert systems: Knowledge tools for physicians . West J Med 1986;;145: 830-839.
21 +
Langlotz CP, Shortliffe EH:  Adapting a consultation system to critique user plans . Int J Man-Machine Stud 1983;;19:479-496.
22 +
Grimm RH, Shimoni K, Harlan WR, et al:  Evaluation of patient-care protocol use by various providers . N Engl J Med 1975;;292:507-511.
23 +
Komaroff AL, Black WL, Flatley M:  Protocols for physician assistants: Management of diabetes and hypertension . N Engl J Med 1974;;290:307-312.
24 +
Bleich HL:  Computer-based consultation: Electrolyte and acid-base disorders . Am J Med 1972;;53:285-291.
25 +
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.
26 +
De Dombal FT, Leaper DJ, Staniland JR, et al:  Computer-aided diagnosis of acute abdominal pain . Br Med J 1972;;1:376-380.
27 +
Weinstein MC, Fineberg HV: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;.
28 +
Pauker SG, Kassirer JP:  Clinical decision analysis by computer . Arch Intern Med 1981;;141: 1831-1837.
29 +
Gorry GA, Kassirer JP, Essig A, et al:  Decision analysis as the basis for computer-aided management of acute renal failure . Am J Med 1973;;55: 473-484.
30 +
Clancey WJ, Shortliffe EH (eds): Readings in Medical Artificial Intelligence: The First Decade . Reading, Mass, Addison-Wesley Publishing Co, 1984;.
31 +
Szolovits P (ed): Artificial Intelligence in Medicine . Boulder, Colo, Westview Press (AAAS Symposium Series), 1982;.
32 +
Elstein AS, Shulman LS, Sprafka SA: Medical Problem Solving: An Analysis of Clinical Reasoning . Cambridge, Mass, Harvard University Press, 1978;.
33 +
Kuipers B, Kassirer JP:  Causal reasoning in medicine: Analysis of a protocol . Cognitive Sci 1984;;8:363-385.
34 +
Duda RO, Shortliffe EH:  Expert systems research . Science 1983;;220:261-268.
35 +
Pauker SG, Gorry GA, Kassirer JP, et al:  Toward the stimulation of clinical cognition: Taking a present illness by computer . Am J Med 1976;;60: 981-996.
36 +
Shortliffe EH: Computer-Based Medical Consultations: MYCIN . New York, Elsevier/North Holland, 1976;.
37 +
Buchanan BG, Shortliffe EH (eds): Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project . Reading, Mass, Addison-Wesley Publishing Co, 1984;.
38 +
Weiss S, Kulikowski CA, Safir A:  Glaucoma consultation by computer . Comput Biol Med 1978;; 8:24-40.
39 +
Shortliffe EH:  The computer and clinical decision making: Good advice is not enough . IEEE Eng Med Biol Mag 1982;;1:16-18.
40 +
Shneiderman B: Designing the User Interface: Strategies for Effective Human-Computer Interaction . Reading, Mass, Addison-Wesley Publishing Co, 1986;.
41 +
Teach RL, Shortliffe EH:  An analysis of physician attitudes regarding computer-based clinical consultation systems . Comput Biomed Res 1981;; 14:542-558.
42 +
Schwartz WB, Patil RS, Szolovits P:  Artificial intelligence in medicine: Where do we stand? N Engl J Med 1987;;316:685-688.
43 +
Aikins JS, Kunz JC, Shortliffe EH, et al:  PUFF: An expert system for interpretation of pulmonary function data . Comput Biomed Res 1983;;16:199-208.
44 +
Weiss SM, Kulikowski CA, Galen RS:  Developing microprocessor-based expert models for instrument interpretation , in Proceedings of the Seventh International Joint Conference on Artificial Intelligence. Los Altos, Calif, Morgan-Kauffman Publishers, 1981 , pp 853-855.
45 +
Miller RA, Schaffner KF, Meisel A:  Ethical and legal issues related to the use of computer programs in clinical medicine . Ann Intern Med 1985;;102:529-536.
46 +
Yu VL, Fagan LM, Wraith SM, et al:  Antimicrobial selection by a computer: A blinded evaluation by infectious disease experts . JAMA 1979;; 242:1279-1282.
47 +
Young FE:  Validation of medical software: Present policy of the Food and Drug Administration . Ann Intern Med 1987;;106:628-629.
48 +
National Library of Medicine: Long Range Plan: Medical Informatics (Report of Panel 4) . Bethesda, Md, National Institutes of Health, 1986;.
49 +
Association of American Medical Colleges:  Physicians for the 21st century (report of the Panel on the General Education of the Physician and College Preparation for Medicine) . J Med Educ 1984;;59:1-208.
50 +
Schwartz WB:  Medicine and the computer: The promise and problems of change . N Engl J Med 1970;;283:1257-1264.
51 +
Shortliffe EH:  The science of biomedical computing . Med Informatics 1984;;9:185-193.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lindberg DAB, Schoolman HM:  The National Library of Medicine and medical informatics . West J Med 1986;;145:786-790.
2 +
Collen MF:  Full-text medical literature retrieval by computer: A pilot test . JAMA 1985;;254:2768-2774.
3 +
Greenes RA:  Knowledge management as an aid to medical decision making and education: The EXPLORER-1 system , in Proceedings of MEDINFO-86. Amsterdam, North Holland, 1986 , pp 895-899.
4 +
Tatro DS, Briggs RL, Chavez-Pardo R, et al:  Online drug interaction surveillance . Am J Hosp Pharm 1975;;32:417-420.
5 +
Blois MS, Tuttle MS, Sheretz DD:  RECONSIDER: A program for generating differential diagnoses , in Proceedings of the Fifth Symposium on Computer Applications in Medical Care . Washington, DC, IEEE Computer Society Press, 1981;, pp 263-268.
6 +
Barnett GO, Cimino JJ, Hupp JA, et al:  DXplain: An evolving diagnostic decision-support system . JAMA 1987;;258:67-74.
7 +
Miller RA, Pople HE Jr, Myers JD:  Internist-1: An evolving computer-based diagnostic consultant for general internal medicine . N Engl J Med 1982;;307:468-476.
8 +
Miller RA, McNeil MA, Challinor SM, et al:  The Internist-1/Quick Medical Reference Project: Status report . West J Med 1986;;145:816-822.
9 +
Ledley RS, Lusted LB:  Reasoning foundations of medical diagnosis . Science 1959;;130:9-21.
10 +
Warner HR, Toronto AF, Veasy LG:  Experience with Bayes' theorem for computer diagnosis of congenital heart disease . Ann NY Acad Sci 1964;; 115:2-16.
11 +
Medical Education in the Information Age (Proceedings of a Symposium on Medical Informatics) . Washington, DC, Association of American Medical Colleges, 1986;.
12 +
Reggia JA, Tuhrim S (eds): Computer-Assisted Medical Decision Making . New York, Springer-Verlag NY Inc, 1985;.
13 +
Warner HR: Computer-Assisted Medical Decision Making . New York, Academic Press Inc, 1978;.
14 +
Pryor RA, Garner RM, Clayton PD, et al:  The HELP System . J Med Syst 1983;;7:87-102.
15 +
McDonald CJ, Hui SL, Smith DM, et al:  Reminders to physicians from an introspective computer medical record . Ann Intern Med 1984;;100: 130-138.
16 +
Reggia JR, Tabb OR, Price TR, et al:  Computer-aided assessment of transient ischemic attacks . Arch Neurol 1984;;41:1248-1254.
17 +
Miller PL: Expert Critiquing Systems: Practice-Based Medical Consultation by Computer . New York, Springer-Verlag NY Inc, 1986;.
18 +
Evans RS, Larsen RA, Burke JP, et al:  Computer surveillance of hospital-acquired infections and antibiotic use . JAMA 1986;;256:1007-1011.
19 +
Hickam DH, Shortliffe EH, Bischoff MB, et al:  The treatment advice of a computer-based cancer chemotherapy protocol advisor . Ann Intern Med 1985;;103:928-936.
20 +
Shortliffe EH:  Medical expert systems: Knowledge tools for physicians . West J Med 1986;;145: 830-839.
21 +
Langlotz CP, Shortliffe EH:  Adapting a consultation system to critique user plans . Int J Man-Machine Stud 1983;;19:479-496.
22 +
Grimm RH, Shimoni K, Harlan WR, et al:  Evaluation of patient-care protocol use by various providers . N Engl J Med 1975;;292:507-511.
23 +
Komaroff AL, Black WL, Flatley M:  Protocols for physician assistants: Management of diabetes and hypertension . N Engl J Med 1974;;290:307-312.
24 +
Bleich HL:  Computer-based consultation: Electrolyte and acid-base disorders . Am J Med 1972;;53:285-291.
25 +
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.
26 +
De Dombal FT, Leaper DJ, Staniland JR, et al:  Computer-aided diagnosis of acute abdominal pain . Br Med J 1972;;1:376-380.
27 +
Weinstein MC, Fineberg HV: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;.
28 +
Pauker SG, Kassirer JP:  Clinical decision analysis by computer . Arch Intern Med 1981;;141: 1831-1837.
29 +
Gorry GA, Kassirer JP, Essig A, et al:  Decision analysis as the basis for computer-aided management of acute renal failure . Am J Med 1973;;55: 473-484.
30 +
Clancey WJ, Shortliffe EH (eds): Readings in Medical Artificial Intelligence: The First Decade . Reading, Mass, Addison-Wesley Publishing Co, 1984;.
31 +
Szolovits P (ed): Artificial Intelligence in Medicine . Boulder, Colo, Westview Press (AAAS Symposium Series), 1982;.
32 +
Elstein AS, Shulman LS, Sprafka SA: Medical Problem Solving: An Analysis of Clinical Reasoning . Cambridge, Mass, Harvard University Press, 1978;.
33 +
Kuipers B, Kassirer JP:  Causal reasoning in medicine: Analysis of a protocol . Cognitive Sci 1984;;8:363-385.
34 +
Duda RO, Shortliffe EH:  Expert systems research . Science 1983;;220:261-268.
35 +
Pauker SG, Gorry GA, Kassirer JP, et al:  Toward the stimulation of clinical cognition: Taking a present illness by computer . Am J Med 1976;;60: 981-996.
36 +
Shortliffe EH: Computer-Based Medical Consultations: MYCIN . New York, Elsevier/North Holland, 1976;.
37 +
Buchanan BG, Shortliffe EH (eds): Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project . Reading, Mass, Addison-Wesley Publishing Co, 1984;.
38 +
Weiss S, Kulikowski CA, Safir A:  Glaucoma consultation by computer . Comput Biol Med 1978;; 8:24-40.
39 +
Shortliffe EH:  The computer and clinical decision making: Good advice is not enough . IEEE Eng Med Biol Mag 1982;;1:16-18.
40 +
Shneiderman B: Designing the User Interface: Strategies for Effective Human-Computer Interaction . Reading, Mass, Addison-Wesley Publishing Co, 1986;.
41 +
Teach RL, Shortliffe EH:  An analysis of physician attitudes regarding computer-based clinical consultation systems . Comput Biomed Res 1981;; 14:542-558.
42 +
Schwartz WB, Patil RS, Szolovits P:  Artificial intelligence in medicine: Where do we stand? N Engl J Med 1987;;316:685-688.
43 +
Aikins JS, Kunz JC, Shortliffe EH, et al:  PUFF: An expert system for interpretation of pulmonary function data . Comput Biomed Res 1983;;16:199-208.
44 +
Weiss SM, Kulikowski CA, Galen RS:  Developing microprocessor-based expert models for instrument interpretation , in Proceedings of the Seventh International Joint Conference on Artificial Intelligence. Los Altos, Calif, Morgan-Kauffman Publishers, 1981 , pp 853-855.
45 +
Miller RA, Schaffner KF, Meisel A:  Ethical and legal issues related to the use of computer programs in clinical medicine . Ann Intern Med 1985;;102:529-536.
46 +
Yu VL, Fagan LM, Wraith SM, et al:  Antimicrobial selection by a computer: A blinded evaluation by infectious disease experts . JAMA 1979;; 242:1279-1282.
47 +
Young FE:  Validation of medical software: Present policy of the Food and Drug Administration . Ann Intern Med 1987;;106:628-629.
48 +
National Library of Medicine: Long Range Plan: Medical Informatics (Report of Panel 4) . Bethesda, Md, National Institutes of Health, 1986;.
49 +
Association of American Medical Colleges:  Physicians for the 21st century (report of the Panel on the General Education of the Physician and College Preparation for Medicine) . J Med Educ 1984;;59:1-208.
50 +
Schwartz WB:  Medicine and the computer: The promise and problems of change . N Engl J Med 1970;;283:1257-1264.
51 +
Shortliffe EH:  The science of biomedical computing . Med Informatics 1984;;9:185-193.

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