Capturing clinical expertise. A computer program that considers clinical responses to digitalis

G. Anthony Gorry, Howard D Silverman, Stephen G. Pauker

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

The administration of digitalis by experienced cardiologists has been examined and a prototypical computer program has been developed which captures portions of their expertise. The new program first constructs a patient-specific model upon which to base the determination of dosage and then uses feedback information about a variety of clinical aspects of the patient's response to modify its recommendations. The model reflects both the program's knowledge of pharmacokinetics and those special features of the patient's condition which may alter his response to therapy. The program makes assessments of the therapeutic and the toxic effects of digitalis on the patient, and bases its subsequent recommendations on the "therapeutic-toxic" state which best describes the evolving clinical situation. A clinical trial was performed in which the program "followed" a series of patients managed by clinicians on a cardiology service. That trial demonstrated the feasibility of this type of program in dealing with acutely ill patients, even those who have increased sensitivity to the toxic effects of digitalis. Each patient in the trial in whom toxicity developed had received more digitalis than would have been recommended by the program. This approach to automated clinical consultation should eventually provide a technology for the distribution of clinical expertise.

Original languageEnglish (US)
Pages (from-to)452-460
Number of pages9
JournalAmerican Journal of Medicine
Volume64
Issue number3
DOIs
StatePublished - 1978
Externally publishedYes

Fingerprint

Digitalis
Software
Poisons
Hospital Distribution Systems
Therapeutic Uses
Cardiology
Referral and Consultation
Pharmacokinetics
Clinical Trials
Technology
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Capturing clinical expertise. A computer program that considers clinical responses to digitalis. / Gorry, G. Anthony; Silverman, Howard D; Pauker, Stephen G.

In: American Journal of Medicine, Vol. 64, No. 3, 1978, p. 452-460.

Research output: Contribution to journalArticle

@article{fc177d1682c342569d24bbc4e40412aa,
title = "Capturing clinical expertise. A computer program that considers clinical responses to digitalis",
abstract = "The administration of digitalis by experienced cardiologists has been examined and a prototypical computer program has been developed which captures portions of their expertise. The new program first constructs a patient-specific model upon which to base the determination of dosage and then uses feedback information about a variety of clinical aspects of the patient's response to modify its recommendations. The model reflects both the program's knowledge of pharmacokinetics and those special features of the patient's condition which may alter his response to therapy. The program makes assessments of the therapeutic and the toxic effects of digitalis on the patient, and bases its subsequent recommendations on the {"}therapeutic-toxic{"} state which best describes the evolving clinical situation. A clinical trial was performed in which the program {"}followed{"} a series of patients managed by clinicians on a cardiology service. That trial demonstrated the feasibility of this type of program in dealing with acutely ill patients, even those who have increased sensitivity to the toxic effects of digitalis. Each patient in the trial in whom toxicity developed had received more digitalis than would have been recommended by the program. This approach to automated clinical consultation should eventually provide a technology for the distribution of clinical expertise.",
author = "Gorry, {G. Anthony} and Silverman, {Howard D} and Pauker, {Stephen G.}",
year = "1978",
doi = "10.1016/0002-9343(78)90232-2",
language = "English (US)",
volume = "64",
pages = "452--460",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Capturing clinical expertise. A computer program that considers clinical responses to digitalis

AU - Gorry, G. Anthony

AU - Silverman, Howard D

AU - Pauker, Stephen G.

PY - 1978

Y1 - 1978

N2 - The administration of digitalis by experienced cardiologists has been examined and a prototypical computer program has been developed which captures portions of their expertise. The new program first constructs a patient-specific model upon which to base the determination of dosage and then uses feedback information about a variety of clinical aspects of the patient's response to modify its recommendations. The model reflects both the program's knowledge of pharmacokinetics and those special features of the patient's condition which may alter his response to therapy. The program makes assessments of the therapeutic and the toxic effects of digitalis on the patient, and bases its subsequent recommendations on the "therapeutic-toxic" state which best describes the evolving clinical situation. A clinical trial was performed in which the program "followed" a series of patients managed by clinicians on a cardiology service. That trial demonstrated the feasibility of this type of program in dealing with acutely ill patients, even those who have increased sensitivity to the toxic effects of digitalis. Each patient in the trial in whom toxicity developed had received more digitalis than would have been recommended by the program. This approach to automated clinical consultation should eventually provide a technology for the distribution of clinical expertise.

AB - The administration of digitalis by experienced cardiologists has been examined and a prototypical computer program has been developed which captures portions of their expertise. The new program first constructs a patient-specific model upon which to base the determination of dosage and then uses feedback information about a variety of clinical aspects of the patient's response to modify its recommendations. The model reflects both the program's knowledge of pharmacokinetics and those special features of the patient's condition which may alter his response to therapy. The program makes assessments of the therapeutic and the toxic effects of digitalis on the patient, and bases its subsequent recommendations on the "therapeutic-toxic" state which best describes the evolving clinical situation. A clinical trial was performed in which the program "followed" a series of patients managed by clinicians on a cardiology service. That trial demonstrated the feasibility of this type of program in dealing with acutely ill patients, even those who have increased sensitivity to the toxic effects of digitalis. Each patient in the trial in whom toxicity developed had received more digitalis than would have been recommended by the program. This approach to automated clinical consultation should eventually provide a technology for the distribution of clinical expertise.

UR - http://www.scopus.com/inward/record.url?scp=0017796545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0017796545&partnerID=8YFLogxK

U2 - 10.1016/0002-9343(78)90232-2

DO - 10.1016/0002-9343(78)90232-2

M3 - Article

C2 - 637058

AN - SCOPUS:0017796545

VL - 64

SP - 452

EP - 460

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 3

ER -