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Expert Systems and Decision Support in Medicine 33rd Annual Meeting of the GMDS EFMI Special Topic Meeting Peter L. Reichertz Memorial Conference Hannover, September 26-29, 1988 Proceedings Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Editorial Board J.Anderson J.H. van Bemmel M.F.Collen F.Gremy S.Kaihara A. Levy O.A.B. Lindberg (Managing Editor) H. Peterson A. Pratt P. L. Reichertzt E. H. Shortliffe W Spencer K. Uberla C. Val bona Editors O. Rienhoff Institut fUr Medizinische Informatik, Philipps-Universitiit Marburg BunsenstraBe 3, 0-3550 Marburg U. Piccolo B. Schneider Institut fur Medizinische Informatik, Medizinische Hochschule Hannover Konstanty-Gutschow-StraBe 8, 0-3000 Hannover 61 ISBN 978-3-540-50317-0 ISBN 978-3-642-48706-4 (eBook) DOI 10.1007/978-3-642-48706-4 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specificslly the rights of translation, reprinting, re-use of illustrations, recitation, brosdcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1988 2127/3140-543210 - Printed on acid-free paper FOREWORD The 33rd Annual Meeting of the German Association for Medical Documentation, Informatics and Statistics was combined with a Special Topic Conference of the European Federation for Medical Informatics and takes place at Hannover, F.R. of Germany, from September 26 to 29, 1988. It was planned and initililly prepared by the late Prof. P.L Reichertz, who headed the Hannover institute from 1969 to 1987. To commemorate his contribution to the development of medicine the conference was devoted to him "Peter Reichertz Memorial Conference on Expert Systems and Decision Support in Medicine" Since computers in the early Fifties were first applied to support medical reasoning, various phases of euphoria and resi~ation have .followed. Every new methodology which became technically possible was and will be applied to the old questlon of how to diagnose diseases more reliably. Artificial Intelligence is just one new approach to the old challenge. Over the years some· authors have been very optimistic and put forward opinions which motivated the common press to coin the phrase 'Dr.med.computer'. Papers printed under this heading rebuffed the majority of physiCians for many years. Today we know that medical decision making is a most complex buman performance. And 30 years of research on decision support have given us only limited insight into the underlying processes. Most of the principal methodological questions were already asked very early on. After many field tests of prototype systems we have a solid body of knowledge on what does not work and why. It is therefore an invaluable experience for all of us to read the literature and to relate our own research to the many papers already published on the topic. In reviewing the contributions for this book we tried to motivate the authors to analyze this literature and to scientifically discuss their results in their papers. Our e~riences in editing these proceedings were not always positive: some authors seem to find thelr argumentation so striking that it aoes not need any scientific disCltssion, some seem to believe that high-tech editing of manuscripts is more important than the meaningful scientific content of the paper. We therefore decidcil not to include some manuscripts in thiS volume. After so many years of work on medical decision support researchers need time to review and to systematize. This was the intention of this specill.l topic conference on decision support in medicine. The editors strongly believe that researchers need a meta-methodology in order to develop computer support for medical reasoning and to more easily relate their research efforts to a systematized anarXSis of the experiences gathered thus avoiding unnecessary efforts in toy systems that have to fall. We hope that this proceedings volume will contribute to this aim. Finally, we would like to thank all our colleagues in Hannover, namely I. Chami, A Heimers, A Peter, B. SchAfer, R. Koch and B. Engelke, who helped to prepare this volume. Hannover, July 1988 Otto Rienhoff Ursula Piccolo Berthold Schneider III Table of Contents INTRODUCTION AND MEMORIAL SESSION Decision Support in Medicine Comparative Methodology and Impact on the Medical Curriculum Bemme~ 1.H. van 3 SPECIAL TOPIC CONTRIBUTIONS Decision Support in Western Clinical Medicine Medical Practice -Decision Making: A Logical Model Moidu, K; Driankov, D.; Wigertz, O. 23 New Decision Support Concepts for the Pharmacy Application in the HELP System Prokosch, H.u.; Hulse, RK; Wal~ M.; Wong, T.w.; Pryor, T.A. 31 ROPES -A Rule-Based Outpatient Expert System Moon, Y.S.; Lo, T.F. 38 DIACONS -A Consultation System to Assist in the Management of Diabetes Schneider, 1.; Piwemetz, K; Engelbrecht, R; Renner, R 44 Using Default Reasoning to Find Interactions of Drugs Dicht~ M. 50 Decision Support for Cardiac Care Unit Admission -Evaluation of Methodological Approaches in Relation to Clinical Applicability Tusch, G.; Rienhoff, 0.; Reichertz, P.L.+; VICtOr, N. 55 MESSE -A Medical Expert System of Special Examinations Balkany~ L; Molnar, K; Santa, E.; Toth, M. 60 Decision Support System in Oncology HyOdynmaa, S.; Kolari, P.; Niiriiiinen, K; Ojala, A.; Rantanen, 1.; Saranumm~ N. 65 A Computer-Aided Diagnosis System for Lung Cancer Yang, Z.-N.; Fang, 1.-Q. 69 Medical Diagnosis by Negotiation Amongst Experts Werner, G. 74 Aiding Medical Inferences by the Relational Rules Acquired from Medical Experts; Consultation System for Use in a Gynecologic Out-Patient Clinic 78 Ruszkows~ 1. IV Decision Support in Traditional Chinese Medicine Principles of Developing Expert Systems of Traditional Chinese Medicine Qin, D. 85 Computer Simulation System on Diagnosing and Treating Hypertension by Traditional Chinese Medicine Associated with Modem Medicine Deng, Q.; Fu, w.; Liang. Z. '4 An Expert System for Diagnosing and Treating Ectopic Pregnancy with Combined Traditional Chinese and Western Medicines Xie, B.; Yao, CX; Yu, ZJ. '8 Knowledge-Based Systems and Statistical Decision Support Statistical Reasoning and Learning in Knowledge-bases Represented as Causal Networks Spiegelhalter, D.!.; Lauritzen, St.L. lOS The Use of the Diagnostic Paradigm in Modelling Medical Decision Making Feldmann, U. 113 The Computer-Aided DitTerential Diagnosis of Diseases of the Urinary Tract in Children Wang, Q.; Wang. Q.; Sh~ H. 120 Qualitative Modelling in Vascular Surgery Dessi, N.; Fanni, A.; Manca, M.G.; Scintu, F.; 126 Statistical Approach to the Acute Abdomen Diagnosis in Children Emparanza,!. 1.; Aldamiz-Echevarria, L.; Perez-Yarza, E.G.; Aldazabal, P.; Tovar, !. 131 A Probabilistic Approach to Health Care Delivery in Tropical Africa Byass, P. 136 A New Approach to the Solution of Decision Making Problems in Medical Expert Systems Czoga1a, E.; Brodziak, A. 142 Computer-Assisted Construction of Conceptual Frameworks for Health Systems Research Hornung, B.R.; Opitz, E. 146 Clinical Studies and Decision Support A Strategy for Identifying Clusters of Similar Response Hecker, H. 15S Error Rate Estimation in Discriminant Analysis in the Presence of Variable Selection KOnig, !. 162 v Assessment of the Diagnostic Importance ofBAL-F1uid Values with ROC-Curves Zaiss, A w.; Costabe~ u.; Klar, R 169 Scoring Systems and Compnter-Aided Prognosis in Patients with Bleeding Oesophageal or Gastric Varices Ohmann, C.; StOltzing, H; Wms, L.; Thon, K; 175 On the Use of Statistical Expert Systems for Supporting Quality Assurance in Analysis of Oinieal Trials Wzttkowsld, KM. 182 Informatics as Applied to Expert Systems An Expert System for Interpretation and Diagnosis of ECG Signals Ledos, J.P.; Colas des Francs, X; Strauss, A.; Le Beux, P.; Auvert, B.; Fontaine, D. 191 An Expert System for Genetic Counseling u.; Seuchter, S.A.; Prokosch, H Keir, D.; Skolnick, M.H MECOS-2: An Artificial Intelligence Tool System for Developing Medical Expert Systems in Various Subjects Guo, c.-G. 202 Diagnostic Expert Systems in Neurology -A Comparison between a Rule Based Prototype and a Database Oriented Approach Bunke, H; Flilcldger, F.; Ludin, HP.; Conti, F. 209 ~iction of MSOF EVOlut~~ ~eans of. Nine Vital Systems Trltiectories c.; PlZZl, R.; De Gaetano. A; G up" P.; ChIara, 0.; Columbano, Sicurello, F. 213 An Expert System for Cardiopulmonary Diseases in Primary Health Care Cano, F.; Lazaro, P.; Luna, G.; Marin, E.; Martin, J.; del Rio, A.; Santesmases, J.G.; Yurramend~ Y. 218 Experiences with Expert Systems Knowledge-Based Decision Support for Laryngeal Tumor Diseases: Design and Structure of the ESTHER System Haux, R; Holmer. J.; Ingeneif, J.; Repges, R; Richter, M.M.; Mosges, R; Schlondorjf, G.; Schmelzer, B. 225 An Expert System for Diagnosis and Therapy Planning in Patients with Ovarian Cancer Giron, A.; George, M.; Jan, P.; Pejovic, M.H; Wartelle, M.; Le Beux, P.; Flamant, R 235 Electrolyte and Haemostasis Test Interpretation by Expert Systems on Microcompnter in Medical Laboratory Pradella, M.; Dorizzi, R; Giavarina, D.; Camerotto, A.; Rigolin, F. VI Representation of Neuroanatomle:al Knowledge by PROLOG Ohe, K; Kaihara, Sh. Knowledge-Based Decision Support for Monitoring in Anesthesia: Problems, Design and User Interaction Schecke, Th.; Langen, M.; Rau, G.; KiJsmacher, H.; Kalff, G.; 256 Shock Trauma Manual Computer Consultation Expert System L~ w,; Zhao, R 264 An Expert System for Medical Evacnations Nagy, LL; Christensen, B.; Nagy, T.L 270 A Computer Oriented Diagnosis of Acute Renal Failure in the Critically III Patient Michetti, v,; Cavaliere, F.; Sciarra, M; Proiem R; Vagnoni, S. 275 Decision Support in Medical Management of Personnel Resources: Duty Roster in an Anesthesiologic Department Pollwein, B.; Beyer, A.; Gier~ L; Heyde, G. 279 Computer.Aided Diagnosis: Experience with Knowledge Based Methods Schnabe~ M; Ruch, u.; Eckardt, M.; Thunnayr, R. 283 A Commonly Used Expert System of Traditional Chinese Medicine (TCM) Sh~ C. 288 On the Assessment of Medical Expert Systems Rossi Morl, A; Ricc~ F.L 292 nata Bases and Expert Systems PBASE: A Prolog BASEd Query Language Hm, L-C.; Le Beux, P. 301 Case Description and Case Retrieval on TIme Oriented Patient Data Bernauer, 1.; Rading, M.; Tusch,. G.; Reichertz, P.L +; Gubernatis, G.; Pichlmayr, R; 308 ARTEL: An Expert System in Hypertension for the General Practitioner Lavri~ M.; Chatellier, G.; Degoulet, P.; Sauquet, D., Jeunemaitre, X; Menard, 1.; Rovani, C. 314 Computer Assisted Generation of Heuristic Rules in the Management of Cardiac Arrhythmias Binder, Th. 322 A Bac~und Knowledge Base to Assist Coding of Medical Documents RiccardI, M.; Rossi Morl, A. 328 DES: A Domain Independent Expert System Running on a Microcomputer: Diagnostle: of Thyroid Disorders Degner, F.L; Santen, R. 334 Extraction of Knowledge from a Database Chowdhury, S.L; Wigertz, a.B. 338 VII A CoDlputer-Based Referenee System for Medical Diagnosis W'Jeding, J.u.; Naue, T.; SchOnle, P.w. 343 Know1ed&e Acquisition tor Sdlente-Based Medical Expert Systems: The Dysmorphic Syndrome Example Gierl, L.; Arias-Lewing, G.; Stengel-Rutkowski, S.; Jakobeit, M.; Lohse, K 347 Evaluation and Measuring ofBeDeftt of an Expert System for Dift'erential Diagnosis in Rheumatology Schewe, S.; Schemnann, w.; Gierl, L. 352 POSCH Experience Intearatlq Expert Systems and Clinkal Data Analyses Long, J.M.; Slagle, J.R.; WICk, }./.R.; Irani, EA.; Weisman, P.R.; Matts, J.P.; Claikson, P.F. 355 Future Trends and Possibilities Status of and Research Needs for Expert SYSteDlS in Medicine Engelbrecht, R. 361 Statistics, Modelling, Operational Research, Decision-Making and Expert Systems in the Public Health Control of Infectious Diseases Bailey, IV. TJ . 367 Expert SySteDl Knowledge Transfer W'JgeTtz, O.B.; Clayton, P.D.; Haug, PJ .; Pryor, T.A. 371 Philosophical Considerations about the Illusions and Delusions of Informatics in Health and Medicine Gremy, F. 378 FREE CONTRIBUTIONS Statistical and Laboratory Animals Methods Statistische und Tierexperimentelle Verfahren Estimation of the Conftdence Interval of a Rate and the Choice of Sample Size Konfidenzbereichsschitzungen einer Rate und Wahl der StichprobengroBe BiJhning, D. 387 Sensitivity of the Multi-Process Kalman Filter for Renal Transplant Mouitorlng .. Sensitivitit des Multi-Process Kalman-Filter fUr das Uberwachen von Nierentransplantat-Patienten Mau,J. 393 Experiences with Explorative and Conftrmative Evaluations of a Prospective Study on Gravidity . ~en mit explorativen und konfirmativen Auswertungen einer prospektiVen Scbwangerscbaftsstudie Koller, S. 400 VIII Methods of Estimation of Cancer Prevalence in the F.R. of Germany Methoden der Pravalenzschitzung von Krebserkrankungen in der Bundesrepublik Deutschland Meisner, Chr.; Pietsch-Breitfeld, B. 405 Computer Simulation of the Kinetics of LabeUed Cells in the Intestinal Tract Computersimulation der Kinetik von markierten Zellen im Darmepithel w.; Chen, Meinier, H.-P.,. Sandblad, B. 412 Monitoring and Securing Data Quality in Multicentre Clinical Trials Die Oberwachung und Sicherung der Datenqualitat bei multizentrischen klinischen Studien Fischer, Chr.; Holle, R. 416 Skewness and Kurtosis of the Distribution of Body Weight in Artificial Populations of Laboratory Rats Schiefe und WOlbung der Verteilung der Korpergewichte in Kunstpopulationen von Laboratoriumsratten Corsing, c.; Glirtner, K; Rapp, K 421 Medical Documentation and Information Systems Medizinische Dokumentations-und Informationssysteme Advantages and Disadvantages of Decentral Documentation Systems Gewinn und Gefahren dezentraler Dokumentationssysteme Wieding, 1.u.; Kretschmar, T. 429 Computerized Textstring Standardization in the Medical Basic Documentation Computerunterstiitzte Textstandardisierung in der medizinischen Basisdokumentation Graubner, B. 435 Syntax Analysis of CytopatholoRical Summaries Syntaktische Analyse zytopathofogischer Beurteilungstexte Pietrzyk, P.M. 443 A Knowledge-Based System for Interactive Medical Diagnosis Encoding Ein wissensbasiertes System zur Verschliisselung natfulichsprachiger medizinischer Diagnosen Wagner, 1.; Baud, R.; Borst, F.; KOhler, C.-D.; Scherrer, 1.-R. 449 Knowledge-based Indexing of Medical Phrases on the Basis of SNOMED: Methodolo~cal Considerations and the Realisation of EIDOS Wissensbaslertes Indexieren von medizinischen Phrasen auf der Basis von SNOMED: Methodik und Realisation von EIDOS Ingenerf, 1.; Haux, R.; Repges, R.; Richter, M.M. 455 Managing the Evolution of an Integrated Hospital Infomation System by Using Efficient Concepts, Methods and Tools Zur Evolution eines integrierten Krankenhausinformations-und Kommunikationssystems unter Verwendung leistungsfahiger informations technischer Konzepte, Methoden und Werkzeuge Carstensen, K; Hedderich, 1.; Sauter, K 462 IX