Methods Inf Med 1994; 33(04): 417-422
DOI: 10.1055/s-0038-1635037
Original Article
Schattauer GmbH

An Integrated Knowledge-Based System to Guide the Physician During Structured Reporting

K. Kuhn
1   University of Ulm, Germany
,
T. Zemmler
1   University of Ulm, Germany
,
M. Reichert
1   University of Ulm, Germany
,
D. Rösner
1   University of Ulm, Germany
,
O. Baumiller
1   University of Ulm, Germany
,
H. Knapp
1   University of Ulm, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2018 (online)

Abstract:

A routinely used system for report generation, based on direct physician data entry, has been combined with a knowledge-based module. The knowledge-based system is operating in the background, and guides the user by dynamically suggesting diagnoses and generating hints regarding the actual and possible further diagnostic procedures. Hybrid technology with neural networks and rules is used. A laboratory evaluation has shown good agreement between diagnoses suggested by the system and confirmed diagnoses, with a kappa coefficient of 0.85 and an area under the ROC curve of 0.92. In a survey following a 14-day test period, physicians stated that the system was both sensible and helpful. The current application domain is ultrasound reporting.

 
  • REFERENCES

  • 1 Komaroff AL. The variability and inaccuracy of medical data. Proc IEEE 1979; 67: 1196-207.
  • 2 McDonald CJ, Tiemey WM. Computer-stored medical records. JAMA 1988; 251: 3433-40.
  • 3 Bell DS, Greenes RA, Doubilet P. Form-based clinical input from a structured vocabulary: initial application in ultrasound reporting. In: Frisse ME. ed. Proc 16th Symposium on Computer Applications in Medical Care 1992. New York: McGraw-Hill; 1992: 789-90.
  • 4 Benoit RG, Canfield K, Teitelbaum S. et al. Frame-based clinical data entry: design issues for physician acceptance. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O. eds. MEDINFO 92. Amsterdam: North-Holland; 1992: 1280-5.
  • 5 Bernauer J, Gumrich K, Kutz S, Lindner P, Pretschner DP. An interactive report generator for bone scan studies. In: Clayton PD. ed. Proc 15th Symposium on Computer Applications in Medical Care 1991. New York: McGraw-Hill; 1992: 858-60.
  • 6 Nowlan WA, Rector AL, Kay S, Goble CA, Horan B, Hawkins TJ, Wilson A. PEN & PAD: a doctor’s workstation with intelligent data entry and summaries. In: Miller RA. ed. Proc 14th Symposium on Computer Applications in Medical Care 1990. Los Alamitos: IEEE Computer Society Press; 1990: 941-2.
  • 7 Swett HA, Fisher P, Mutalik P, Miller PL, Wright L. The IMAGE/ICON system: voice activated intelligent image display for radiologic diagnosis. In: Kingsland LC. ed. Proc 13th Symposium on Computer Applications in Medical Care 1989. Los Alamitos: IEEE Computer Society Press; 1989: 977-8.
  • 8 Lussier YA, Maksud M, Desruisseuaux B, Yale PP. Pure MD: a computerized patient record software for direct data entry by physicians. In: Frisse ME. ed. Proc 16th Symposium on Computer Applications in Medical Care 1992. New York: McGraw-Hill: 1992: 261-4.
  • 9 Kuhn K, Gaus W, Wechsler JG. et al. Structured reporting of medical findings: evaluation of a system in gastroenterology. Meth Inf Med 1992; 31: 268-74.
  • 10 Gouveia-Oliveira A, Raposo VD, Salgado NC, Almeida I, Nobre-Leitao C, Galvao de FMelo. Longitudinal comparative study on the influence of computers on reporting of clinical data. Endoscopy 1991; 23: 334-7.
  • 11 Ohmann C, Sitter H, de Dombal FT. Objektive medizinische Entscheidungsunterstützung bei akuten Bauchschmerzen. In: Mi-chaelis J, Hommel G, Wellek S. eds. Proc 37th Ann Meeting of the German Society of Medical Informatics, Biometric and Epidemiology (GMDS) 1992. Munich: MMV Medizin Verlag; 1992: 412-6.
  • 12 Kuhn K, Roesner D, Zemmler T. et al. A neural network expert system to support decisions in diagnostic imaging. In: Bank-man IN, Tsitlik JE. eds. Fourth IEEE Symposium on Computer-Based Medical Systems. Los Alamitos: IEEE Computer Society Press; 1991: 244-50.
  • 13 Mulsant BH. A neural netwok as an approach to clinical diagnosis. MD Comput 1990; 07: 25-36.
  • 14 Asada N, Doi K, MacMahon H. et al. Potential usefulness of an artificial neural network for differential diagnosis of interstitial lung diseases: pilot study. Radiology 1990; 177: 2857-60.
  • 15 Rumelhart DE, McClelland JL. eds. Parallel Distributed Processing: Explorations in the Microstructure of Cognition (Vol 1). Cambridge MA: Bradford Books; 1986
  • 16 Dorffner G, Prem E, Mackinger M. et al. Experiences with neural networks as a diagnostic tool in medical image processing. In: Michaelis J, Hommel G, Wellek S. eds. Proc 37th Ann Meeting of the German Society of Medical Informatics, Biometrics and Epidemiology (GMDS). Munich: MMV Medizin Verlag; 1992: 407-11.
  • 17 Kuhn K, Zemmler T, Reichert M, Heinlein C, Roesner D. Structured data collection and knowledge-based user guidance for abdominal ultrasound reporting. In: Safran C. ed. Proc 17th Symposium on Computer Applications in Medical Care 1993. New York: McGraw-Hill; 1993: 311-5.
  • 18 Fleiss JL. Statistical Methods for Rates and Proportions. New York: Wiley; 1981
  • 19 Gjørup T. The kappa coefficient and the prevalence of a diagnosis. Meth Inf Med 1988; 27: 184-6.
  • 20 Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic curve. Radiology 1982; 143: 29-36.
  • 21 Swets JA. Measuring the accuracy of diagnostic systems. Science 1988; 240: 1285-93.
  • 22 Shortliffe EH. Knowledge-based systems in medicine. In: Adlassnig KP, Grabner G, Bengtsson S, Hansen R. eds. Medical Informatics Europe 1991. Berlin: Springer; 1991: 5-9.
  • 23 Miller RA, Masarie FE. The demise of the “Greek Oracle” model for medical diagnostic systems. Meth Inf Med 1990; 29: 1-2.
  • 24 Cimino C, Barnett GO, Hassan L, Blewett DR, Piggins J. Interactive query workstation: standardizing access to computer-based medical resources. Comput Meth Progr Bio-med 1991; 35: 293-9.
  • 25 Greenes RA. “Desktop knowledge”: a new focus for medical education and decision support. Meth Inf Med 1989; 28: 332-9.
  • 26 Wyatt J, Spiegelhalter D. Evaluating medical expert systems: what to test and how?. Med Inf 1990; 15: 205-17.
  • 27 Mann G, Schleicher C, Haux R. et al. Evaluation eines Daten- und Wissensbanksystems fur die neurologische Ultraschalldiagnostik. Biometrie und Informatik in Medizin und Biologie 1992; 23: 100-6.
  • 28 Adlassnig KP, Scheithauer W. Performance evaluation of medical expert systems using ROC curves. Comput Biomed Res 1989; 22: 297-313.
  • 29 Nathwani BN, Heckerman DE, Horvitz EJ, Lincoln TL. Integrated expert systems and videodisc in surgical pathology: an overview. Human Pathol 1990; 21: 11-27.
  • 30 Eberhart RC, Dobbins RW, Hutton LV. Neural network paradigm comparisons for appendicitis diagnoses. In: Bankman IN, Tsitlik JE. eds. Fourth IEEE Symposium on Computer-Based Medical Systems. Los Alamitos: IEEE Computer Society Press; 1991: 298-304.
  • 31 Miller RA. Medical diagnostic decision support systems – past, present, and future. JAMIA 1994; 01: 8-27.
  • 32 Hart A, Wyatt J. Evaluating black boxes as medical decision aids: issues arising from a study of neural networks. Med Inf 1990; 15: 229-36.