Miller RA 1994 "Medical diagnostic decision-support systems - past, present, and future - a threaded bibliography and brief commentary."

Miller RA. Medical diagnostic decision-support systems - past, present, and future - a threaded bibliography and brief commentary. J Am Med Inform Assoc 1994;1(1):8-27.
"Articles about medical diagnostic decision support (MDDS) systems often begin with a disclaimer such as, ''despite many years of research and millions of dollars of expenditures on medical diagnostic systems, none is in widespread use at the present time.'' While this statement remains true in the sense that no single diagnostic system is in widespread use, it is misleading with regard to the state of the art of these systems. Diagnostic systems, many simple and some complex, are now ubiquitous, and research on MDDS systems is growing. The nature of MDDS systems has diversified over time. The prospects for adoption of large-scale diagnostic systems are better now than ever before, due to enthusiasm for implementation of the electronic medical record in academic, commercial, and primary care settings. Diagnostic decision support systems have become an established component of medical technology. This paper provides a review and a threaded bibliography for some of the important work on MDDS systems over the years from 1954 to 1993."
To provide "a review and a threaded bibliography for some of the important work on MDDS systems over the years from 1954 to 1993."
Tools Used
not applicable
Type of Health IT
Decision support system
Type of Health IT Functions
"When researchers in medical informatics encounter the term "medical diagnostic decision support systems," many think primarily of, general-purpose, broad-spectrum consultation systems. However, a key distinction must be made in reviewing and analyzing MDDS systems. There exist systems for general diagnosis
(no matter how broad or narrow their application domains) and systems for diagnosis in specialized domains, such as interpretation of [electrocardiogram] ECG tracings...The diversity of MDDS systems continues to increase."
Workflow-Related Findings
"[I]t is common wisdom that MDDS systems are most likely to succeed when they can be integrated into a clinical environment so that patient data capture is already performed by automated laboratory and/or hospital information systems. In such an environment, the physician will not have to manually enter all of a patient's data in order to obtain a diagnostic consultation."
"A key aspect of a system's acceptability is its user interface. The graphic user interfaces (GUIs) that are now available facilitate system usage by physicians who have difficulty typing, but many physicians are as uncomfortable using pointing devices as they are typing. Systems must provide flexible environments that adapt to the user's needs and problems, rather than providing an interface that is inflexible and penalizes the user for deviating from the normal order of system operation. It must be easy to move from one program function to another if it is common for the health care user to do so on his or her own mentally. Transitions must be facilitated when frequent patterns of usage emerge."
"Another important area related to the scope and context of system evaluations is health care practitioners' attitudes toward computers and diagnostic systems, and introspection into the proper clinical role for computers in medicine. Developers must be aware that documenting that a system performs as intended will not guarantee its acceptance by the general medical community. Sociologic, cultural, and financial issues have as much to do with the success or failure of a system as do technological aspects."
Study Design
Systematic literature review
Study Participants
The author identified, "1665 references from being relevant to MDDS systems...In the preparation of this article, an attempt was made to select representative projects and ideas, but it is not possible to be comprehensive. In general, whenever a researcher, a project, a laboratory, or a topic relevant to MDDS systems is cited, an attempt has been made to cite subsequent publications from the same source in order to provide a threaded history of relevant work. Only a small number of systems are discussed in this commentary, and many of the discussions are abbreviated and superficial." The author highlights, "[W]ork on human diagnostic problem solving," "[e]arly MDSS system research as the foundation for present MDSS system development," "[t]rends in current and future work on MDSS systems," and "[t]he future of diagnostic decision support systems."