Interactive computer graphics support of medical decision-making

Results from experimental psychology indicate that interpretation is often faster and more accurate when the information is presented in a graphic format. Through the use of computer graphics technology, the objective of this research and development project was to improve the presentation of clinical information. A library of computer graphics methods (PALGRAPH) was developed to facilitate the development of clinical applications. The library includes tools visualizing diagnostic and therapeutic data, displaying reference areas, and providing user and data driven animation for highlighting abnormalities. Through the use of the PALGRAPH library, a labor curve presentation program was developed. It provides a combined graphic display of timed progressive cervical dilatation, fetal station, and stimulation of uterine activity (oxytocin infusion). For the earlier detection of abnormalities, phase specific normal ranges (reference areas) are displayed. In addition, protraction/arrest as well as precipitate labor disorders are highlighted and computer messages are displayed. The performance of the program was evaluated through the assessment of 405 labors entered into a local area network of computers. On an average, 1.5 abnormalities per recorded labor (2.0 for labors resulting in vaginal delivery) were identified by the program. The graphic presentation of the labor curve, produced within 3 seconds, displayed 27% more information than the tabular format on the same screen area. The graphic presentation could provide a single-screen display of the labor curve for all patients. A controlled study of the differential effects of computer graphics presentation on the detection and recall of labor abnormalities has been conducted. Twenty physicians interpreted the labor data of 12 patients. Half of the 240 labor data presentations were in graphics format, the other half in tabular format. Both types of presentation displayed the normal ranges and highlighted the abnormalities detected by the computer. There were 18% more labor abnormalities recorded when the data were presented graphically--primarily as a result of better sensitivity. The difference in sensitivity associated with the graphic presentation was significantly larger among residents than among the attending physicians. Graphic presentation also improved the recall of recorded labor abnormalities by 11%.