Pediatric Informatics: Computer Applications in Child Health (Health ...

12 Diagnostic Decision Support 167
Fig. 12.2 DXplain: Evidence for Disease: Neonatal Sepsis
for adult and pediatric forms. Users enter an average of four non-demographic
findings per case. Additional findings are often entered from the system’s prompts
called “Findings present?”. After an initial analysis, the system asks the user if findings
with high TF or ES are present or absent. Findings with high TF for a given
disease that are absent help to rule out that disease; findings with high ES that are
present raise the support for that disease.
The system is available via the World Wide Web. Advantages over prior distribution
methods (e.g. PC–based versions) include the ability to update the system
easily and to collect feedback from users. Such feedback has proven to be a very
useful resource for the DXplain editors to correct knowledge base errors and
deficiencies and to improve the program. In the last five years, over 11,000 users
have accessed the application each year. 22
In 2006, Epocrates Sx, which uses a subset of the DXplain KB, was developed
jointly by the LCS and Epocrates. The program allows users to enter clinical findings
on a handheld computer. It then displays an index of plausible diagnoses,
which are hyperlinked to the Epocrates Dx product, which is based on the 5 Minute
Clinical Consult textbook. 23
Limitations of the system include:
Prevalence values that are not regionally adjusted (though in some diseases,
geographic prevalence is listed as a clinical finding, e.g. “North American,
Southwestern” in “Coccidioidomycosis”).