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

168 M.J. Feldman
Incorrect or missing data from the KB are possible sources of error (user
feedback and quality assurance measures by the developers allow for continuing
updates to help correct these).
Certain combinations of independent but nonspecific findings can underweight
a diagnosis. (For example, in a young adult female with amenorrhea and
nausea, the probability of pregnancy is higher than the individual findings
might suggest). Recently, the ability to cluster findings was added to DXplain
to allow the program to deal with these situations. This can be especially useful
in raising the likelihood of a disease in a child that might not otherwise deserve
consideration in the elderly. For example, one cluster will increase the likelihood
of infectious mononucleosis in an adolescent or young adult with sore throat
and fatigue. Despite these clusters, diagnoses may still be missed when many
findings with low PPV are entered.
A few studies have evaluated DXplain’s performance. In one study, 29 of 34
respondents found the system useful in expanding the differential diagnosis. 24 In
a series of case presentations where only preliminary findings were entered, the
system listed the correct or nearly correct diagnosis in seven of ten cases. 25 In a
study of four MDDSS systems, DXplain listed the “correct” diagnosis in 69% of
105 diagnostically challenging cases (in some of these cases, the correct diagnosis
was not contained in DXplain’s KB), 75% when adjusted to cases (96) whose
diagnoses were contained in the KB. DXplain suggested an average of two or
more additional diagnoses per case that expert physicians found relevant but did
not consider. 26 In a study of the system at a teaching hospital, 80% of residents
using the system stated it was useful, 94% stated the system was easy to use and
over 70% stated the system provided them with diagnoses they would not have
otherwise considered. 27
12.5.2 GIDEON
Intended function
� Diagnostic decision support limited to infectious diseases
Mode by which advice is offered
� Passive: User accesses system when needed
Consultation style
� Consulting model
Underlying decision-making process
� Bayesian matrix
Human–computer interaction
� Streamlined intuitive modular interface
GIDEON (Global Infectious Diseases and Epidemiology Network) is an MDDSS
that contains data on 337 infectious diseases and 231 countries, available via CD