An Application of automated decision logic in diagnostic radiology.

The ability of computers to accumulate and evaluate information and to make it rapidly available on demand is aiding physicians. Computers are especially valuable in helping to make accurate diagnoses quickly. Results of radiologic examinations, including those using ultrasound, computed tomography and nuclear medicine, are needed in the computer along with other data to give the physician a complete picture. Radiologists have been reluctant to enter their findings into computers because the process was time consuming and it was difficult to remember in detail the necessary coding procedure for data entry. Part of the difficulty in coding resulted from the wide variety of possible pathological and normal states. The purpose of this paper is to describe a computerized system developed at the 550 bed LDS Hospital in Salt Lake City for order and reporting radiologic examinations. This system captures and reports clinically relevant findings and reduces the amounts of effort required of the radiologist. The unique feature of the system is the generation of an individualized list of the most likely diagnostic possibilities for each examination ordered. The radiologist reports findings by selecting from the list. The selections are entered into the computer by clerical personnel. Radiology examinations are ordered from CRT computer terminals which are located at each nursing station in the hospital. The person ordering the examination selects the desired procedure and indicates the reason for performing the examination. An automatically generated requisition/report provides the radiologist with a list of the five most likely findings for the specified procedure. In addition to mechanisms for data collection, storage, and retrieval, a system for automated decision making (HELP) is in use at the LDS Hospital. HELP allows a user to specify criteria for medical decisions using natural language. These criteria are compiles into decision logic sectors which are activated whenever data referenced in that decision logic is added to the data base. The clinical data base contains the results of any previous radiological examinations, the admitting diagnosis, the results of a self administered history, ECG interpretation, pulmonary function and blood gas data, vital signs and demographic data, clinical laboratory data, medications, surgical procedures, and heart cauterization findings. The system is designed to minimize the effort required by the radiologist and still obtain salient information which can be integrated at part of the computerized clinical data base.