A Practical Computer Program That Diagnoses Diseases In Actual Patients
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Transcript of A Practical Computer Program That Diagnoses Diseases In Actual Patients
![Page 1: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/1.jpg)
A PRACTICAL
COMPUTER
PROGRAM
THAT DIAGNOSES DISEASES
IN ACTUAL PATIENTS
Carlos Feder &
Tomás Feder
![Page 2: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/2.jpg)
A PRACTICAL COMPUTER PROGRAM
THAT DIAGNOSES DISEASES IN ACTUAL PATIENTS
Carlos Feder & Tomás Feder
![Page 3: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/3.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
![Page 4: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/4.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
![Page 5: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/5.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
Physicians order an inordinate number of futile tests, not rationally
selected according to a probabilistically determined benefit
![Page 6: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/6.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
Physicians order an inordinate number of futile tests, not rationally
selected according to a probabilistically determined benefit
These errors are due to the impossibility to remember or even learn
thousands of diseases with their corresponding names, symptoms,
tests, procedures, causes, mechanisms, etc.
![Page 7: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/7.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
Physicians order an inordinate number of futile tests, not rationally
selected according to a probabilistically determined benefit
These errors are due to the impossibility to remember or even learn
thousands of diseases with their corresponding names, symptoms,
tests, procedures, causes, mechanisms, etc.
Diseases neither learned nor recalled by the physician remain
undiagnosed or misdiagnosed
![Page 8: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/8.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
Physicians order an inordinate number of futile tests, not rationally
selected according to a probabilistically determined benefit
These errors are due to the impossibility to remember or even learn
thousands of diseases with their corresponding names, symptoms,
tests, procedures, causes, mechanisms, etc.
Diseases neither learned nor recalled by the physician remain
undiagnosed or misdiagnosed
Problem compounded by time constraints imposed by health
insurances (managed care medicine)
![Page 9: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/9.jpg)
ESSENTIAL NEED FOR AN EFFICIENT
COMPUTER DIAGNOSTIC PROGRAM
Diagnostic errors occur very frequently; some are disabling or fatal,
resulting in liability for the physician. Unawareness, underreported
Physicians order an inordinate number of futile tests, not rationally
selected according to a probabilistically determined benefit
These errors are due to the impossibility to remember or even learn
thousands of diseases with their corresponding names, symptoms,
tests, procedures, causes, mechanisms, etc.
Diseases neither learned nor recalled by the physician remain
undiagnosed or misdiagnosed
Problem compounded by time constraints imposed by health
insurances (managed care medicine)
Computers can store the contents of many medical texts and swiftly
retrieve the needed information anywhere and at any time
![Page 10: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/10.jpg)
EXISTING SO CALLED
“COMPUTER DIAGNOSTIC PROGRAMS”
INTERNIST (former Caduceus)
MEDITEL
QMR (Quick Medical Reference)
ILIAD
PKC (Problem-Knowledge Couplers)
ISABEL
DXplain
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EXISTING SO CALLED
“COMPUTER DIAGNOSTIC PROGRAMS”
INTERNIST (former Caduceus)
MEDITEL
QMR (Quick Medical Reference)
ILIAD
PKC (Problem-Knowledge Couplers)
ISABEL
DXplain
Excellent remainder of unusual diagnoses, but
Unable to pinpoint the disease(s) that actually afflict a specific patient
Considered educational or training tools rather than diagnostic tools
Poorly accepted and seldom used by practicing health care providers
![Page 12: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/12.jpg)
Advantages of our novel computer program
![Page 13: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/13.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
![Page 14: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/14.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
![Page 15: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/15.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
It diagnoses concurrent diseases afflicting simultaneously a specific patient
![Page 16: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/16.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
It diagnoses concurrent diseases afflicting simultaneously a specific patient
It calculates accurately the probability of each diagnosis with our novel mini-max
procedure, instead of applying inexact Bayes formula or other methods
![Page 17: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/17.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
It diagnoses concurrent diseases afflicting simultaneously a specific patient
It calculates accurately the probability of each diagnosis with our novel mini-max
procedure, instead of applying inexact Bayes formula or other methods
It gives primary importance to the cost of obtaining each clinical datum. Our algorithm
interprets cost not only as dollar expense, but also considers discomfort and risk of the
procedure. Four overall cost categories are established: No Cost, Small Cost,
Intermediate Cost, and Great Cost
![Page 18: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/18.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
It diagnoses concurrent diseases afflicting simultaneously a specific patient
It calculates accurately the probability of each diagnosis with our novel mini-max
procedure, instead of applying inexact Bayes formula or other methods
It gives primary importance to the cost of obtaining each clinical datum. Our algorithm
interprets cost not only as dollar expense, but also considers discomfort and risk of the
procedure. Four overall cost categories are established: No Cost, Small Cost,
Intermediate Cost, and Great Cost
It anticipates the benefit that each clinical datum would confer to each diagnosis in the
differential diagnosis list, by calculating with our mini-max procedure how much it would
increase or decrease the current probability of the corresponding diagnosis if the data
were found respectively present or absent in the patient
![Page 19: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/19.jpg)
Advantages of our novel computer program
It confirms one or more diseases that indeed afflict a specific patient, instead of
displaying a long list of potential diagnoses that compete with each other
It rules in diagnoses evoked by clinical data present, but also rules out those diagnoses
that are not viable, based on sensitivity of clinical data absent
It diagnoses concurrent diseases afflicting simultaneously a specific patient
It calculates accurately the probability of each diagnosis with our novel mini-max
procedure, instead of applying inexact Bayes formula or other methods
It gives primary importance to the cost of obtaining each clinical datum. Our algorithm
interprets cost not only as dollar expense, but also considers discomfort and risk of the
procedure. Four overall cost categories are established: No Cost, Small Cost,
Intermediate Cost, and Great Cost
It anticipates the benefit that each clinical datum would confer to each diagnosis in the
differential diagnosis list, by calculating with our mini-max procedure how much it would
increase or decrease the current probability of the corresponding diagnosis if the data
were found respectively present or absent in the patient.
It selects and recommends the probabilistically calculated best cost-benefit clinical data
to investigate next in the patient at each diagnostic step, to achieve more efficiently and
economically a final diagnosis
![Page 20: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/20.jpg)
Advantages of our novel computer program(continues)
![Page 21: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/21.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
![Page 22: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/22.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
![Page 23: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/23.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
It includes complex clinical presentation models in the database, which list associations
among diseases, such as causes, complications, and other relations, precluding
overlooking associated diseases
![Page 24: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/24.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
It includes complex clinical presentation models in the database, which list associations
among diseases, such as causes, complications, and other relations, precluding
overlooking associated diseases
It deals with interactions between concurrent diseases or drugs that mask important
clinical data of the primary disease, precluding the improper ruling out of the
corresponding diagnosis
![Page 25: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/25.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
It includes complex clinical presentation models in the database, which list associations
among diseases, such as causes, complications, and other relations, precluding
overlooking associated diseases
It deals with interactions between concurrent diseases or drugs that mask important
clinical data of the primary disease, precluding the improper ruling out of the
corresponding diagnosis
It proposes an easy way to handle synonyms of diagnoses and clinical data
![Page 26: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/26.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
It includes complex clinical presentation models in the database, which list associations
among diseases, such as causes, complications, and other relations, precluding
overlooking associated diseases
It deals with interactions between concurrent diseases or drugs that mask important
clinical data of the primary disease, precluding the improper ruling out of the
corresponding diagnosis
It proposes an easy way to handle synonyms of diagnoses and clinical data
It is ease to update
![Page 27: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/27.jpg)
Advantages of our novel computer program(continues)
It recommends a set of best cost-benefit clinical data to be investigated simultaneously
in the patient, based on diverse heuristic strategies
It can display selected partial lists that render the diagnostic task more economic and
manageable, without compromising the accuracy of the result. It accomplishes this
through parameters that can be set at diverse values and through abridged output files,
giving the user the choice to select the ones that fit best his or her preferences
It includes complex clinical presentation models in the database, which list associations
among diseases, such as causes, complications, and other relations, precluding
overlooking associated diseases
It deals with interactions between concurrent diseases or drugs that mask important
clinical data of the primary disease, precluding the improper ruling out of the
corresponding diagnosis
It proposes an easy way to handle synonyms of diagnoses and clinical data
It is ease to update
Such an algorithm, if successful in medicine, may represent a more general model of
reasoning; a paradigm of mental structure and functioning applicable to other inexact
disciplines such as law, sociology, politics, defense, or corporate strategy
![Page 28: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/28.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM
![Page 29: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/29.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
![Page 30: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/30.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
![Page 31: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/31.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
![Page 32: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/32.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
4. On the other hand, if best cost-benefit function proves probabilistically that a
diagnostic procedure is absolutely necessary, it will force managed care
organizations and insurers to authorize such procedures, otherwise curtailed for
being expensive
![Page 33: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/33.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
4. On the other hand, if best cost-benefit function proves probabilistically that a
diagnostic procedure is absolutely necessary, it will force managed care
organizations and insurers to authorize such procedures, otherwise curtailed for
being expensive
5. Facilitates and improves utilization reviews by hospitals, laboratories, and other
providers.
![Page 34: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/34.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
4. On the other hand, if best cost-benefit function proves probabilistically that a
diagnostic procedure is absolutely necessary, it will force managed care
organizations and insurers to authorize such procedures, otherwise curtailed for
being expensive
5. Facilitates and improves utilization reviews by hospitals, laboratories, and other
providers.
6. Protect health care providers against unfounded malpractice liability
![Page 35: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/35.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
4. On the other hand, if best cost-benefit function proves probabilistically that a
diagnostic procedure is absolutely necessary, it will force managed care
organizations and insurers to authorize such procedures, otherwise curtailed for
being expensive
5. Facilitates and improves utilization reviews by hospitals, laboratories, and other
providers.
6. Protect health care providers against unfounded malpractice liability
7. Helps to overcome the current well known resistance of physicians to resort to
computerized aid for medical diagnosis
![Page 36: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/36.jpg)
SOCIOECONOMIC ADVANTAGES
OF OUR PROGRAM1. Reduces significantly the current numerous diagnostic errors and their dismal
consequences
2. Saves specialist consultations; important in emergencies and in underdeveloped
areas were specialists are not available
3. Reduces significantly the number of futile tests and procedures, by recommending
the best cost-benefit clinical data to investigate next in a patient. This saves
expense, risk, and discomfort for the patient and saves social medical resources
4. On the other hand, if best cost-benefit function proves probabilistically that a
diagnostic procedure is absolutely necessary, it will force managed care
organizations and insurers to authorize such procedures, otherwise curtailed for
being expensive
5. Facilitates and improves utilization reviews by hospitals, laboratories, and other
providers.
6. Protect health care providers against unfounded malpractice liability
7. Helps to overcome the current well known resistance of physicians to resort to
computerized aid for medical diagnosis
8. Some concepts of our diagnostic program are applicable and necessary to properly
implement the current renewed enthusiasm for long needed universal electronic
storage of medical records
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DEMONSTRATION
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DEMONSTRATION
A 32-year-old white female grade-school teacher with recent onset of
palpitations. Six months ago she lost her job, followed by
nervousness and depression. At that time a complete physical
examination and basic lab tests were normal; she was treated with an
antidepressant, without improving. Her medical condition gradually
worsened and recently the mentioned palpitations added to the clinical
picture, motivating the present consultation. The medical examination
revealed the following clinical data.
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CLINCAL DATA PRESENT
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CLINCAL DATA PRESENT
No Cost clinical data
Medical History (symptoms)
C0072 (palpitations)
C0216 (nervousness/anxiety)
C0606 (depression)
C0050 (fatigue, asthenia)
C0109 (sweating, diaphoresis, perspiration)
C0161 (weight loss)
C0165 (diarrhea)
C0010 (dyspnea, breathlessness, shortness of breath)
Physical Examination (physical signs)
C0078 (tachycardia)
C0219 (fine texture of skin/hair)
C0224 (exophthalmos)
C0490 (conjunctival redness)
C0222 (lid lag)
C0220 (goiter, enlarged thyroid gland)
C0095 (loud first heart sound)
C0053 (systolic murmur)
C0111 (weakness)
C0223 (tremor)
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CLINCAL DATA ABSENT
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CLINCAL DATA ABSENT
No Cost clinical data
Medical History (symptoms)
C0498 (male)
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DIFFERENTIAL DIAGNOSIS LIST
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 818----------D0004 (MITRAL STENOSIS/RHEUMATIC HEART DISEASE)total P: 640----------D0012 (PHEOCHROMOCYTOMA)total P: 364----------D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338----------D0002 (AORTIC VALVE STENOSIS)total P: 332----------D0035 (ROCKY MOUNTAIN SPOTTED FEVER)total P: 272----------D0057 (ACUTE MYOCARDIAL INFARCTION WITH MASKED CHEST PAIN)total P: 183----------D0005 (ACUTE MYOCARDIAL INFARCTION WITHOUT MASKED CHEST PAIN)total P: 183----------D0027 (DISSEMINATED GONOCOCCAL INFECTION)total P: 181----------D0069 (PANCREATIC BODY-TAIL CARCINOMA)total P: 176----------
D0046 (PANCREATIC HEAD CARCINOMA)total P: 176----------D0001 (AORTIC DISSECTION)total P: 169----------D0007 (PULMONARY EMBOLISM)total P: 157----------D0026 (INTESTINAL GIARDIASIS)total P: 145----------D0022 (ULCERATIVE COLITIS)total P: 145----------D0024 (ACUTE INFECTIVE ENDOCARDITIS)total P: 138----------D0038 (SYSTEMIC LUPUS ERYTHEMATOSUS)total P: 132----------D0059 (DIABETIC KETOACIDOSIS)total P: 110----------D0021 (CROHN'S DISEASE, REGIONAL ENTERITIS)total P: 107----------D0034 (PNEUMOCOCCAL PNEUMONIA)total P: 100----------
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Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 103
G0001 MEDICAL HISTORYC0353 (abdominal pain, right lower quadrant)C0800 (abdominal pain, left lower quadrant)C0799 (abdominal pain, right upper quadrant)C0246 (abdominal pain, epigastric)C0781 (abdominal pain, left upper quadrant)C0697 (inadequate insulin administration)C0352 (mucus in stool)C0615 (dysuria)C0538 (photosensitivity)C0533 (pericarditis)C0215 (hypersensitivity to heat)C0486 (onset May-September)C0458 (vaginal discharge)C0401 (urinary tract symptoms, female)C0400 (urinary tract symptoms, male)
Continues…
G0002 PHYSICAL EXAMINATIONC0864 (urethral discharge)C0860 (urethritis)C0859 (cervicitis)C0853 (small intestine obstruction)C0854 (colonic obstruction)C0794 (systolic thrill)C0793 (unequal blood pressures)C0702 (Kussmaul respiration)C0529 (butterfly, malar rash)C0475 (chest dullness at percussion)C0402 (tenosynovitis/periarthritis)C0398 (dehydration)C0379 (new/worsened regurgitant murmur)
Continues…
Small cost best cost-benefit clinical data: 92
G0003 ELECTROCARDIOGRAMC0377 (abnormal ECG)C0120 (myocardial infarction pattern on ECG)C0065 (left ventricular hypertrophy on ECG)C0577 (myocardial infarction pattern on ECG, with masked chest pain)C0048 (myocardial infarction pattern on ECG, without masked chest pain)
G0004 LABORATORY TESTSC0867 (nucleic acid urogenital probe tests for gonococcus)C0788 (CA 19-9)C0705 (plasma ketones ++++)
C0704 (moderate hyperosmolality: 300 – 320 mOsm/mL)C0703 (glucose: 250 – 600mg/dL)C0710 (hypertriglyceridemia, triglycerides > 250 mg/dL)C0711 (hyperlipoproteinemia)C0679 (plasma D-dimer ELISA)C0535 (ANA, antinuclear antibodies)C0526 (hypergammaglobulinemia)C0518 (casts)C0496 (latex agglutination test for rocky mountain spotted fever)C0495 (indirect immunofluorescence assay for rocky mountain spotted fever)C0386 (C-reactive protein)C0384 (multiple blood cultures for acute endocardits)C0244 (elevated plasma and urine catecholamines and metanephrines)C0243 (elevated twenty four-hour urine vanillylmandelic acid)C0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)C0214 (hypophosphatemia)
Continues…
G0005 RADIOLOGYC0680 (Westermark's, Hampton's, and Palla's signs on chest x-rays)C0338 ("string sign" on x-rays)C0329 (pleural effusion on imaging)C0134 (pulmonary infiltrate on imaging)C0330 (pancreatic head mass on abdominal ultrasound)C0681 (venous ultrasonography with Doppler imaging)C0044 (transthoracic aorta ultrasound for aortic dissection)
Continues…
G0007 ECHOCARDIOGRAMC0664 (echocardiogram for MI)C0378 (valvular vegetations on transesophageal echocardiogram)C0070 (aortic valve stenosis on echocardiogram)C0102 (mitral stenosis on echocardiogram)
Intermediate cost best cost-benefit clinical data: 33
G0004 LABORATORY TESTSC0396 (string test)C0189 (abnormal glucose tolerance)
G0005 RADIOLOGYC0856 (upper GI series with small bowel follow-through for Crohn's disease)C0242 (barium enema for ulcerative colitis)C0027 (gastrograffin enema for Crohn's disease)
Continues…G0006 ULTRASOUNDC0792 (transesophageal ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0797 (echocardiogram of atrial septal defect secundum)
G0008 IMAGING: CT AND/OR MRIC0902 (magnetic resonance colangio-pancreatography for body or tail mass)C0901 (magnetic resonance colangio-pancreatography for head)C0851 (multidetector-row CT with oral contrast for Crohn's disease)C0834 (positron-emission tomography (PET) for pheochromocytoma)C0798 (mitral stenosis on cardiac magnetic resonance imaging)C0784 (pancreatic body or tail mass on CT or MRI)C0682 (multislice spiral chest CT or MRI for pulmonary embolism)C0670 (liver imaging with CT or MRI: fatty liver)C0612 (spiral CT scanning for pancreatic head carcinoma)C0785 (spiral CT scanning for pancreatic body or tail carcinoma)
Continues…
G0009 SCANNINGC0833 (nuclear medicine scintigraphy with MIBG for pheochromocytoma)C0157 (lung perfusion scan with ventilation scan: high probability)C0233 (thyroid radionuclide scan)
G0010 ENDOSCOPYC0850 (wireless capsule endoscopy for Crohn's disease)C0153 (colonoscopy and biopsy for Crohn's disease)
Continues…
G0011 BIOPSYC0497 (biopsy and immunologic exam for R. rickettsii of a rash lesion)C0399 (biopsy of small intestine for Giardia lamblia)
Great cost best cost-benefit clinical data: 14
G0010 ENDOSCOPYC0898 (endoscopic ultrasound and fine-needle aspiration for body)C0608 (ERCP for pancreatic head carcinoma)
Continues…
G0011 BIOPSYC0611 (biopsy for pancreatic head carcinoma)C0786 (biopsy for pancreatic body or tail carcinoma)
G0013 ANGIOGRAPHYC0787 (pancreatic body or tail mass on angiography)C0047 (aortography)C0071 (aortic valve stenosis on catheterization)C0160 (pulmonary angiogram)
Continues…
Total: 242
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PARAMETERS Trim Present No Cost 800 Trim Absent No Cost 800 Trim Present Greater Cost 800 Trim Absent Greater Cost 800 Present Difference Cost 000 Absent Difference Cost 000 Confirmation Threshold 900 Deletion Threshold 100 Cutoff Present 100 Cutoff Absent 900
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Abridged Data Cost Procedure QuantityNo Cost best cost-benefit clinical data: 35
G0001 MEDICAL HISTORYC0353 (abdominal pain, right lower quadrant)C0800 (abdominal pain, left lower quadrant)C0781 (abdominal pain, left upper quadrant)C0780 (strong analgesics)C0673 (pregnancy)C0401 (urinary tract symptoms, female)C0333 (malabsorption)C0296 (gross blood in stool)C0262 (acholic, pale, clay-colored stool)C0215 (hypersensitivity to heat)C0163 (anorexia, loss of appetite)C0127 (arthralgia)C0004 (chest pain)C0052 (history of angina pectoris)C0107 (diabetes)
G0002 PHYSICAL EXAMINATIONC0794 (systolic thrill)C0678 (paradoxical bradycardia)C0562 (Horner's syndrome)C0475 (chest dullness at percussion)C0379 (new/worsened regurgitant murmur)C0375 (meningism)C0365 (skin lesions)C0337 (mouth lesions)C0332 (intestinal fistulas)C0248 (jaundice, icterus)C0238 (funduscopic abnormalities for pheochromocytoma)C0147 (tachypnea)C0015 (abdominal tenderness)C0018 (fever)C0019 (hypertension)C0022 (heart murmur)C0054 (clinical data of advanced age)C0055 (delayed second heart sound)C0074 (right ventricular abnormal maximal impulse)C0094 (mitral opening snap)
Small Cost best cost-benefit clinical data: 27
G0004 LABORATORY TESTSC0867 (nucleic acid urogenital probe tests for gonococcus)C0788 (CA 19-9)C0789 (CA 19-9)C0705 (plasma ketones ++++)
C0819 (increased troponins with masked chest pain)C0829 (increased troponins without masked chest pain)C0679 (plasma D-dimer ELISA)C0535 (ANA, antinuclear antibodies)C0496 (latex agglutination test for rocky mountain spotted fever)C0495 (indirect immunofluorescence assay for rocky mountain spotted fever)C0884 (sputum culture for pneumococcus)C0395 (antigen detection in stool)C0384 (multiple blood cultures for acute endocardits)C0345 (serologic markers for Crohn's disease: ASCA)C0852 (serologic markers for ulcerative colitis: pANCA)C0244 (elevated plasma and urine catecholamines and metanephrines)C0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)C0151 (increased bilirubin)C0131 (increased ESR)C0033 (leukocytosis)
G0005 RADIOLOGYC0042 (abnormal aortic contour on chest x-ray; widening of mediastinum)C0085 (cardiac enlargement on imaging; usually due to right ventric. enlarg.)C0086 (increased pulmonary artery and/or vascular engorgement on imaging)
G0006 ULTRASOUNDC0044 (transthoracic aorta ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0070 (aortic valve stenosis on echocardiogram)C0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 16
G0005 RADIOLOGYC0856 (upper GI series with small bowel follow-through for Crohn's disease)
G0006 ULTRASOUNDC0792 (transesophageal ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0797 (echocardiogram of atrial septal defect secundum)
G0008 IMAGING: CT AND/OR MRIC0834 (positron-emission tomography (PET) for pheochromocytoma)C0798 (mitral stenosis on cardiac magnetic resonance imaging)C0682 (multislice spiral chest CT or MRI for pulmonary embolism)C0612 (spiral CT scanning for pancreatic head carcinoma)C0785 (spiral CT scanning for pancreatic body or tail carcinoma)C0045 (aortic dissection on MRI)
G0009 SCANNINGC0833 (nuclear medicine scintigraphy with MIBG for pheochromocytoma)C0233 (thyroid radionuclide scan)C0665 (radionuclide imaging: viable myocardium, ventricular eject.)
G0010 ENDOSCOPYC0153 (colonoscopy and biopsy for Crohn's disease)C0186 (colonoscopy and biopsy for ulcerative colitis)
G0011 BIOPSYC0497 (biopsy and immunologic exam for R. rickettsii of a rash lesion)C0399 (biopsy of small intestine for Giardia lamblia)
Great Cost best cost-benefit clinical data: 7
G0011 BIOPSYC0611 (biopsy for pancreatic head carcinoma)C0786 (biopsy for pancreatic body or tail carcinoma)
G0013 ANGIOGRAPHYC0047 (aortography)C0071 (aortic valve stenosis on catheterization)C0090 (atrial septal defect on arteriography)C0103 (mitral stenosis on catheterization)C0160 (pulmonary angiogram)
Total: 85
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Abridged Data Cost Procedure QuantityNo Cost best cost-benefit clinical data: 35
G0001 MEDICAL HISTORYC0353 (abdominal pain, right lower quadrant)C0800 (abdominal pain, left lower quadrant)C0781 (abdominal pain, left upper quadrant)C0780 (strong analgesics)C0673 (pregnancy)C0401 (urinary tract symptoms, female)C0333 (malabsorption)C0296 (gross blood in stool)C0262 (acholic, pale, clay-colored stool)C0215 (hypersensitivity to heat)C0163 (anorexia, loss of appetite)C0127 (arthralgia)C0004 (chest pain)C0052 (history of angina pectoris)C0107 (diabetes)
G0002 PHYSICAL EXAMINATIONC0794 (systolic thrill)C0678 (paradoxical bradycardia)C0562 (Horner's syndrome)C0475 (chest dullness at percussion)C0379 (new/worsened regurgitant murmur)C0375 (meningism)C0365 (skin lesions)C0337 (mouth lesions)C0332 (intestinal fistulas)C0248 (jaundice, icterus)C0238 (funduscopic abnormalities for pheochromocytoma)C0147 (tachypnea)C0015 (abdominal tenderness)C0018 (fever)C0019 (hypertension)C0022 (heart murmur)C0054 (clinical data of advanced age)C0055 (delayed second heart sound)C0074 (right ventricular abnormal maximal impulse)C0094 (mitral opening snap)
Small Cost best cost-benefit clinical data: 27
G0004 LABORATORY TESTSC0867 (nucleic acid urogenital probe tests for gonococcus)C0788 (CA 19-9)C0789 (CA 19-9)C0705 (plasma ketones ++++)
C0819 (increased troponins with masked chest pain)C0829 (increased troponins without masked chest pain)C0679 (plasma D-dimer ELISA)C0535 (ANA, antinuclear antibodies)C0496 (latex agglutination test for rocky mountain spotted fever)C0495 (indirect immunofluorescence assay for rocky mountain spotted fever)C0884 (sputum culture for pneumococcus)C0395 (antigen detection in stool)C0384 (multiple blood cultures for acute endocardits)C0345 (serologic markers for Crohn's disease: ASCA)C0852 (serologic markers for ulcerative colitis: pANCA)C0244 (elevated plasma and urine catecholamines and metanephrines)C0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)C0151 (increased bilirubin)C0131 (increased ESR)C0033 (leukocytosis)
G0005 RADIOLOGYC0042 (abnormal aortic contour on chest x-ray; widening of mediastinum)C0085 (cardiac enlargement on imaging; usually due to right ventric. enlarg.)C0086 (increased pulmonary artery and/or vascular engorgement on imaging)
G0006 ULTRASOUNDC0044 (transthoracic aorta ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0070 (aortic valve stenosis on echocardiogram)C0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 16
G0005 RADIOLOGYC0856 (upper GI series with small bowel follow-through for Crohn's disease)
G0006 ULTRASOUNDC0792 (transesophageal ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0797 (echocardiogram of atrial septal defect secundum)
G0008 IMAGING: CT AND/OR MRIC0834 (positron-emission tomography (PET) for pheochromocytoma)C0798 (mitral stenosis on cardiac magnetic resonance imaging)C0682 (multislice spiral chest CT or MRI for pulmonary embolism)C0612 (spiral CT scanning for pancreatic head carcinoma)C0785 (spiral CT scanning for pancreatic body or tail carcinoma)C0045 (aortic dissection on MRI)
G0009 SCANNINGC0833 (nuclear medicine scintigraphy with MIBG for pheochromocytoma)C0233 (thyroid radionuclide scan)C0665 (radionuclide imaging: viable myocardium, ventricular eject.)
G0010 ENDOSCOPYC0153 (colonoscopy and biopsy for Crohn's disease)C0186 (colonoscopy and biopsy for ulcerative colitis)
G0011 BIOPSYC0497 (biopsy and immunologic exam for R. rickettsii of a rash lesion)C0399 (biopsy of small intestine for Giardia lamblia)
Great Cost best cost-benefit clinical data: 7
G0011 BIOPSYC0611 (biopsy for pancreatic head carcinoma)C0786 (biopsy for pancreatic body or tail carcinoma)
G0013 ANGIOGRAPHYC0047 (aortography)C0071 (aortic valve stenosis on catheterization)C0090 (atrial septal defect on arteriography)C0103 (mitral stenosis on catheterization)C0160 (pulmonary angiogram)
Total: 85
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CLINCAL DATA PRESENT
No Cost clinical data
Medical History (symptoms)
C0072 (palpitations)
C0216 (nervousness/anxiety)
C0606 (depression)
C0050 (fatigue, asthenia)
C0109 (sweating, diaphoresis, perspiration)
C0161 (weight loss)
C0165 (diarrhea)
C0010 (dyspnea, breathlessness, shortness of breath)
C0215 (hypersensitivity to heat)
Physical Examination (physical signs)
C0078 (tachycardia)
C0219 (fine texture of skin/hair)
C0224 (exophthalmos)
C0490 (conjunctival redness)
C0222 (lid lag)
C0220 (goiter, enlarged thyroid gland)
C0095 (loud first heart sound)
C0053 (systolic murmur)
C0111 (weakness)
C0223 (tremor)
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CLINCAL DATA ABSENT
No Cost clinical data
Medical History (symptoms)
C0498 (male)
C0353 (abdominal pain, right lower quadrant)
C0800 (abdominal pain, left lower quadrant)
C0781 (abdominal pain, left upper quadrant)
C0780 (strong analgesics)
C0673 (pregnancy)
C0401 (urinary tract symptoms, female)
C0333 (malabsorption)
C0296 (gross blood in stool)
C0262 (acholic, pale, clay-colored stool)
C0163 (anorexia, loss of appetite)
C0127 (arthralgia)
C0004 (chest pain)
C0052 (history of angina pectoris)
C0107 (diabetes)
Physical Examination (physical signs)
C0794 (systolic thrill)
C0678 (paradoxical bradycardia)
C0562 (Horner's syndrome)
C0475 (chest dullness at percussion)
C0379 (new/worsened regurgitant murmur)
C0375 (meningism)
C0365 (skin lesions)
C0337 (mouth lesions)
C0332 (intestinal fistulas)
C0248 (jaundice, icterus)
C0238 (funduscopic abnormalities for
pheochromocytoma)
C0147 (tachypnea)
C0015 (abdominal tenderness)
C0018 (fever)
C0019 (hypertension)
C0022 (heart murmur)
C0054 (clinical data of advanced age)
C0055 (delayed second heart sound)
C0074 (right ventricular abnormal maximal impulse)
C0094 (mitral opening snap)
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DIFFERENTIAL DIAGNOSIS LIST
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 671----------D0004 (MITRAL STENOSIS/RHEUMATIC HEART DISEASE)total P: 103----------
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Abridged Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 2G0002 PHYSICAL EXAMINATIONC0221 (thyroid bruit or thrill)C0096 (rumbling diastolic murmur)
Small Cost best cost-benefit clinical data: 3G0004 LABORATORY TESTSC0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)
G0007 ECHOCARDIOGRAMC0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 2G0008 IMAGING: CT AND/OR MRIC0798 (mitral stenosis on cardiac magnetic resonance imaging)
G0009 SCANNINGC0233 (thyroid radionuclide scan)
Great Cost best cost-benefit clinical data: 1G0013 ANGIOGRAPHYC0103 (mitral stenosis on catheterization)
Total: 8
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Abridged Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 2G0002 PHYSICAL EXAMINATIONC0221 (thyroid bruit or thrill)C0096 (rumbling diastolic murmur)
Small Cost best cost-benefit clinical data: 3G0004 LABORATORY TESTSC0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)
G0007 ECHOCARDIOGRAMC0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 2G0008 IMAGING: CT AND/OR MRIC0798 (mitral stenosis on cardiac magnetic resonance imaging)
G0009 SCANNINGC0233 (thyroid radionuclide scan)
Great Cost best cost-benefit clinical data: 1G0013 ANGIOGRAPHYC0103 (mitral stenosis on catheterization)
Total: 8
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Abridged Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 2G0002 PHYSICAL EXAMINATIONC0221 (thyroid bruit or thrill)C0096 (rumbling diastolic murmur)
Small Cost best cost-benefit clinical data: 3G0004 LABORATORY TESTSC0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)
G0007 ECHOCARDIOGRAMC0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 2G0008 IMAGING: CT AND/OR MRIC0798 (mitral stenosis on cardiac magnetic resonance imaging)
G0009 SCANNINGC0233 (thyroid radionuclide scan)
Great Cost best cost-benefit clinical data: 1G0013 ANGIOGRAPHYC0103 (mitral stenosis on catheterization)
Total: 8
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CLINCAL DATA PRESENT
No Cost clinical data
Medical History (symptoms)
C0072 (palpitations)
C0216 (nervousness/anxiety)
C0606 (depression)
C0050 (fatigue, asthenia)
C0109 (sweating, diaphoresis, perspiration)
C0161 (weight loss)
C0165 (diarrhea)
C0010 (dyspnea, breathlessness, shortness of
breath)
C0215 (hypersensitivity to heat)
Physical Examination (physical signs)
C0078 (tachycardia)
C0219 (fine texture of skin/hair)
C0224 (exophthalmos)
C0490 (conjunctival redness)
C0222 (lid lag)
C0220 (goiter, enlarged thyroid gland)
C0095 (loud first heart sound)
C0053 (systolic murmur)
C0111 (weakness)
C0223 (tremor)
Small Cost clinical dataLaboratory Tests
C0229 (suppressed TSH)
C0228 (increased free, uncombined thyroxin, T four
or T three)
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CLINCAL DATA ABSENT
No Cost clinical data
Medical History (symptoms)
C0498 (male)
C0353 (abdominal pain, right lower quadrant)
C0800 (abdominal pain, left lower quadrant)
C0781 (abdominal pain, left upper quadrant)
C0780 (strong analgesics)
C0673 (pregnancy)
C0401 (urinary tract symptoms, female)
C0333 (malabsorption)
C0296 (gross blood in stool)
C0262 (acholic, pale, clay-colored stool)
C0163 (anorexia, loss of appetite)
C0127 (arthralgia)
C0004 (chest pain)
C0052 (history of angina pectoris)
C0107 (diabetes)
Physical Examination (physical signs)
C0794 (systolic thrill)
C0678 (paradoxical bradycardia)
C0562 (Horner's syndrome)
C0475 (chest dullness at percussion)
C0379 (new/worsened regurgitant murmur)
C0375 (meningism)
C0365 (skin lesions)
C0337 (mouth lesions)
C0332 (intestinal fistulas)
C0248 (jaundice, icterus)
C0238 (funduscopic abnormalities for
pheochromocytoma)
C0147 (tachypnea)
C0015 (abdominal tenderness)
C0018 (fever)
C0019 (hypertension)
C0022 (heart murmur)
C0054 (clinical data of advanced age)
C0055 (delayed second heart sound)
C0074 (right ventricular abnormal maximal impulse)
C0094 (mitral opening snap)
C0221 (thyroid bruit or thrill)
C0096 (rumbling diastolic murmur)
Small Cost clinical dataEchocardiogram
C0102 (mitral stenosis on echocardiogram)
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DIFFERENTIAL DIAGNOSIS LIST
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 1000
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Abridged Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 0
Small Cost best cost-benefit clinical data: 0
Intermediate Cost best cost-benefit clinical data: 0
Great Cost best cost-benefit clinical data: 0
Total: 0
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Abridged Data Cost Procedure QuantityNo Cost best cost-benefit clinical data: 35
G0001 MEDICAL HISTORYC0353 (abdominal pain, right lower quadrant)C0800 (abdominal pain, left lower quadrant)C0781 (abdominal pain, left upper quadrant)C0780 (strong analgesics)C0673 (pregnancy)C0401 (urinary tract symptoms, female)C0333 (malabsorption)C0296 (gross blood in stool)C0262 (acholic, pale, clay-colored stool)C0215 (hypersensitivity to heat)C0163 (anorexia, loss of appetite)C0127 (arthralgia)C0004 (chest pain)C0052 (history of angina pectoris)C0107 (diabetes)
G0002 PHYSICAL EXAMINATIONC0794 (systolic thrill)C0678 (paradoxical bradycardia)C0562 (Horner's syndrome)C0475 (chest dullness at percussion)C0379 (new/worsened regurgitant murmur)C0375 (meningism)C0365 (skin lesions)C0337 (mouth lesions)C0332 (intestinal fistulas)C0248 (jaundice, icterus)C0238 (funduscopic abnormalities for pheochromocytoma)C0147 (tachypnea)C0015 (abdominal tenderness)C0018 (fever)C0019 (hypertension)C0022 (heart murmur)C0054 (clinical data of advanced age)C0055 (delayed second heart sound)C0074 (right ventricular abnormal maximal impulse)C0094 (mitral opening snap)
Small Cost best cost-benefit clinical data: 27
G0004 LABORATORY TESTSC0867 (nucleic acid urogenital probe tests for gonococcus)C0788 (CA 19-9)C0789 (CA 19-9)C0705 (plasma ketones ++++)
C0819 (increased troponins with masked chest pain)C0829 (increased troponins without masked chest pain)C0679 (plasma D-dimer ELISA)C0535 (ANA, antinuclear antibodies)C0496 (latex agglutination test for rocky mountain spotted fever)C0495 (indirect immunofluorescence assay for rocky mountain spotted fever)C0884 (sputum culture for pneumococcus)C0395 (antigen detection in stool)C0384 (multiple blood cultures for acute endocardits)C0345 (serologic markers for Crohn's disease: ASCA)C0852 (serologic markers for ulcerative colitis: pANCA)C0244 (elevated plasma and urine catecholamines and metanephrines)C0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)C0151 (increased bilirubin)C0131 (increased ESR)C0033 (leukocytosis)
G0005 RADIOLOGYC0042 (abnormal aortic contour on chest x-ray; widening of mediastinum)C0085 (cardiac enlargement on imaging; usually due to right ventric. enlarg.)C0086 (increased pulmonary artery and/or vascular engorgement on imaging)
G0006 ULTRASOUNDC0044 (transthoracic aorta ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0070 (aortic valve stenosis on echocardiogram)C0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 16
G0005 RADIOLOGYC0856 (upper GI series with small bowel follow-through for Crohn's disease)
G0006 ULTRASOUNDC0792 (transesophageal ultrasound for aortic dissection)
G0007 ECHOCARDIOGRAMC0797 (echocardiogram of atrial septal defect secundum)
G0008 IMAGING: CT AND/OR MRIC0834 (positron-emission tomography (PET) for pheochromocytoma)C0798 (mitral stenosis on cardiac magnetic resonance imaging)C0682 (multislice spiral chest CT or MRI for pulmonary embolism)C0612 (spiral CT scanning for pancreatic head carcinoma)C0785 (spiral CT scanning for pancreatic body or tail carcinoma)C0045 (aortic dissection on MRI)
G0009 SCANNINGC0833 (nuclear medicine scintigraphy with MIBG for pheochromocytoma)C0233 (thyroid radionuclide scan)C0665 (radionuclide imaging: viable myocardium, ventricular eject.)
G0010 ENDOSCOPYC0153 (colonoscopy and biopsy for Crohn's disease)C0186 (colonoscopy and biopsy for ulcerative colitis)
G0011 BIOPSYC0497 (biopsy and immunologic exam for R. rickettsii of a rash lesion)C0399 (biopsy of small intestine for Giardia lamblia)
Great Cost best cost-benefit clinical data: 7
G0011 BIOPSYC0611 (biopsy for pancreatic head carcinoma)C0786 (biopsy for pancreatic body or tail carcinoma)
G0013 ANGIOGRAPHYC0047 (aortography)C0071 (aortic valve stenosis on catheterization)C0090 (atrial septal defect on arteriography)C0103 (mitral stenosis on catheterization)C0160 (pulmonary angiogram)
Total: 85
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Abridged Global Overview
No Cost best cost-benefit clinical data: 35G0001 MEDICAL HISTORYC0353 (abdominal pain, right lower quadrant)D0021 (CROHN'S DISEASE, REGIONAL ENTERITIS)total P: 107absent total P: 35
C0781 (abdominal pain, left upper quadrant)D0069 (PANCREATIC BODY-TAIL CARCINOMA)total P: 176present total P: 800
D0069 (PANCREATIC BODY-TAIL CARCINOMA)total P: 176absent total P: 26
G0002 PHYSICAL EXAMINATION C0794 (systolic thrill)D0002 (AORTIC VALVE STENOSIS)total P: 332present total P: 651
C0678 (paradoxical bradycardia)D0007 (PULMONARY EMBOLISM)total P: 157present total P: 500
D0034 (PNEUMOCOCCAL PNEUMONIA)total P: 100present total P: 649
Continues…
Small Cost best cost-benefit clinical data: 27G0004 LABORATORY TESTSC0867 (nucleic acid urogenital probe tests for gonococcus)D0027 (DISSEMINATED GONOCOCCAL INFECTION)total P: 181present total P: 1000
C0229 (suppressed TSH)D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 818present total P: 1000
C0228 (increased free, uncombined thyroxin, T four or T three)D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 818absent total P: 0
G0005 RADIOLOGYC0042 (abnormal aortic contour on chest x-ray; widening of
mediastinum)D0001 (AORTIC DISSECTION)total P: 169absent total P: 54
C0085 (cardiac enlargement on imaging; usually due to right ventric. enlarg.)
D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338absent total P: 101
G0006 ULTRASOUNDC0044 (transthoracic aorta ultrasound for aortic dissection)D0001 (AORTIC DISSECTION)total P: 169present total P: 1000
G0007 ECHOCARDIOGRAMC0070 (aortic valve stenosis on echocardiogram)D0002 (AORTIC VALVE STENOSIS)total P: 332present total P: 1000
D0002 (AORTIC VALVE STENOSIS)total P: 332absent total P: 0
Continues…
Intermediate Cost best cost-benefit clinical data: 16G0005 RADIOLOGYC0856 (upper GI series with small bowel follow-through for Crohn's
disease)D0021 (CROHN'S DISEASE, REGIONAL ENTERITIS)total P: 107present total P: 1000
G0006 ULTRASOUNDC0792 (transesophageal ultrasound for aortic dissection)D0001 (AORTIC DISSECTION)total P: 169present total P: 1000
G0007 ECHOCARDIOGRAMC0797 (echocardiogram of atrial septal defect secundum)D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338present total P: 1000
D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338absent total P: 0
G0008 IMAGING: CT AND/OR MRIC0834 (positron-emission tomography (PET) for pheochromocytoma)D0012 (PHEOCHROMOCYTOMA)total P: 364present total P: 1000
C0798 (mitral stenosis on cardiac magnetic resonance imaging)D0004 (MITRAL STENOSIS/RHEUMATIC HEART DISEASE)total P: 780present total P: 1000
D0004 (MITRAL STENOSIS/RHEUMATIC HEART DISEASE)total P: 780absent total P: 0
G0009 SCANNINGC0833 (nuclear medicine scintigraphy with MIBG for
pheochromocytoma)D0012 (PHEOCHROMOCYTOMA)total P: 364absent total P: 27
C0233 (thyroid radionuclide scan)D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 818present total P: 1000
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)total P: 818absent total P: 0
G0010 ENDOSCOPYC0153 (colonoscopy and biopsy for Crohn's disease)D0021 (CROHN'S DISEASE, REGIONAL ENTERITIS)total P: 107absent total P: 0
C0186 (colonoscopy and biopsy for ulcerative colitis)D0022 (ULCERATIVE COLITIS)total P: 145present total P: 1000
D0022 (ULCERATIVE COLITIS)total P: 145absent total P: 0
G0011 BIOPSYC0497 (biopsy and immunologic exam for R. rickettsii of a rash lesion)D0035 (ROCKY MOUNTAIN SPOTTED FEVER)total P: 272present total P: 1000
D0035 (ROCKY MOUNTAIN SPOTTED FEVER)total P: 272absent total P: 64
C0399 (biopsy of small intestine for Giardia lamblia)D0026 (INTESTINAL GIARDIASIS)total P: 145present total P: 1000
D0026 (INTESTINAL GIARDIASIS)total P: 145absent total P: 8
Continues…
Great Cost best cost-benefit clinical data: 7G0013 ANGIOGRAPHYC0047 (aortography)D0001 (AORTIC DISSECTION)total P: 169present total P: 1000
D0001 (AORTIC DISSECTION)total P: 169absent total P: 6
C0090 (atrial septal defect on arteriography)D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338present total P: 1000
D0003 (ATRIAL SEPTAL DEFECT SECUNDUM)total P: 338absent total P: 0
Continues…
Total: 85
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Abridged Data Cost Procedure Quantity
No Cost best cost-benefit clinical data: 2G0002 PHYSICAL EXAMINATIONC0221 (thyroid bruit or thrill)C0096 (rumbling diastolic murmur)
Small Cost best cost-benefit clinical data: 3G0004 LABORATORY TESTSC0229 (suppressed TSH)C0228 (increased free, uncombined thyroxin, T four or T three)
G0007 ECHOCARDIOGRAMC0102 (mitral stenosis on echocardiogram)
Intermediate Cost best cost-benefit clinical data: 2G0008 IMAGING: CT AND/OR MRIC0798 (mitral stenosis on cardiac magnetic resonance imaging)
G0009 SCANNINGC0233 (thyroid radionuclide scan)
Great Cost best cost-benefit clinical data: 1G0013 ANGIOGRAPHYC0103 (mitral stenosis on catheterization)
Total: 8
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Abridged Global OverviewNo Cost best cost-benefit clinical data: 2G0002 PHYSICAL EXAMINATION
C0221 (thyroid bruit or thrill)
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
absent total P: 408
C0096 (rumbling diastolic murmur)
D0004 (MITRAL STENOSIS)
total P: 103
present total P: 176
Small Cost best cost-benefit clinical data: 3G0004 LABORATORY TESTS
C0229 (suppressed TSH)
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
present total P: 1000
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
absent total P: 0
C0228 (increased free, uncombined thyroxin, T four or T three)
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
absent total P: 0
G0007 ECHOCARDIOGRAM
C0102 (mitral stenosis on echocardiogram)
D0004 (MITRAL STENOSIS)
total P: 103
present total P: 1000
D0004 (MITRAL STENOSIS)
total P: 103
absent total P: 0
Intermediate Cost best cost-benefit clinical data: 2G0008 IMAGING: CT AND/OR MRI
C0798 (mitral stenosis on cardiac magnetic resonance imaging)
D0004 (MITRAL STENOSIS)
total P: 103
present total P: 1000
D0004 (MITRAL STENOSIS)
total P: 103
absent total P: 0
G0009 SCANNING
C0233 (thyroid radionuclide scan)
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
present total P: 1000
D0011 (HYPERTHYROIDISM, GRAVES' DISEASE)
total P: 671
absent total P: 0
Great Cost best cost-benefit clinical data: 1G0013 ANGIOGRAPHY
C0103 (mitral stenosis on catheterization)
D0004 (MITRAL STENOSIS)
total P: 103
present total P: 1000
D0004 (MITRAL STENOSIS)
total P: 103
absent total P: 0
Total: 8
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WHAT HAPPENED SO FAR ?
The theory behind our diagnostic system, its terminology, principles, and operation were
first published in 2006
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COMPUTERIZED MEDICAL DIAGNOSIS:
A NOVEL SOLUTION TO AN OLD PROBLEM
Carlos Feder 2006
INITIAL
CLINICAL DATA COLLECTION
AND SYNONYM HANDLING
CLINICAL DATA MATCHING
CREATION OF
CLINICAL DATUM LISTS
CREATION OF
DIFFERENTIAL DIAGNOSIS LIST
CALCULATION OF PROBABILITY OF
DIAGNOSES. MINI-MAX PROCEDURE
Step 1. Process
clinical data present
Step 2. Process clinical data absent
Step 3. Create clinical data pairs
Step 4. Create clinical data pair
tables
Step 5. Calculate partial P that
each clinical data pair
confers to each diagnosis
Step 6. Create mini-max tables
Step 7. Determine total P
of the diagnosis
Step 8. Update
differential diagnosis list
CONCLUSION OF DIAGNOSTIC QUEST?
BEST COST-BENEFIT CLINICAL DATUM
NEXT TO INVESTIGATE
Step 1. Select clinical data not yet
investigated in the patient
Step 2. Organize clinical data not yet
investigated according to cost
category, diagnosis, PP value,
and S Step 3. Recommend a new clinical
datum as best clinical datum
assuming it present Step 4. Recommend a new clinical
datum as best clinical datum
assuming it absent
SIMULTANEOUS RECOMMENDATION OF
SEVERAL BEST COST-BENEFIT
CLINICAL DATA
SAFETY CHECK FOR RISK FLAGGED
DIAGNOSES AND CLINICAL DATA
SAFETY CHECK FOR RELATED
CLINICAL ENTITIES
CLINICAL PRESENTATION
MASKING
CONCURRENT DIAGNOSES
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WHAT HAPPENED SO FAR ?
The theory behind our diagnostic system, its terminology, principles, and operation were
first published in 2006
A patent is pending
The computer program that runs our algorithm was written by Tomás Feder in 2007
This computer program provided a prototype, instrumental in confirming essentially all
our novel ideas, enabling to challenge real clinical cases of individual patients and the
theories behind, with excellent diagnostic results; it broadened our understanding of the
medical diagnostic process, dissipating earlier uncertainties, enabling the discovery of
new functions and eliciting ideas that opened an entire new realm in this field. So many
are the simplifications, additions, and codes that execute new functions, that they
justified writing a new book that we published in 2008
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A PRACTICAL
COMPUTER
PROGRAM
THAT DIAGNOSES DISEASES
IN ACTUAL PATIENTS
Carlos Feder &
Tomás Feder
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WHAT HAPPENED SO FAR ?
The theory behind our diagnostic system, its terminology, principles, and operation were
first published in 2006
A patent is pending
The computer program that runs our algorithm was written by Tomás Feder in 2007
This computer program provided a prototype, instrumental in confirming essentially all
our novel ideas, enabling to challenge real clinical cases of individual patients and the
theories behind, with excellent diagnostic results; it broadened our understanding of the
medical diagnostic process, dissipating earlier uncertainties, enabling the discovery of
new functions and eliciting ideas that opened an entire new realm in this field. So many
are the simplifications, additions, and codes that execute new functions, that they
justified writing a new book that we published in 2008
Our prototype includes so far 60 diseases in its database, and diagnoses beautifully real
patients afflicted by any of such diseases
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WHAT NEXT?
Our diagnostic system, in order to accomplish all the envisioned benefits, must have its
database integrated with all currently known diseases, all their clinical data and
corresponding sensitivities. All complex clinical presentation models, which lists
related diagnoses must be created and also included in the database. This task requires
the cooperation of a team of medical specialists.
Our computer program is not a fancy program that opens colorful windows clicking on
menus or icons, but it satisfies all requisite functions of the algorithm and works
efficiently and accurately. This program would benefit from some cosmetic
improvement by an experienced professional programmer, able to make it more
glamorous and attractive.
We hope that Google or somebody else may help and support us with this project.
![Page 68: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/68.jpg)
WHAT NEXT?
Our diagnostic system, in order to accomplish all the envisioned benefits, must have its
database integrated with all currently known diseases, all their clinical data and
corresponding sensitivities. All complex clinical presentation models, which lists
related diagnoses must be created and also included in the database. This task requires
the cooperation of a team of medical specialists.
Our computer program is not a fancy program that opens colorful windows clicking on
menus or icons, but it satisfies all requisite functions of the algorithm and works
efficiently and accurately. This program would benefit from some cosmetic
improvement by an experienced professional programmer, able to make it more
glamorous and attractive.
We hope that Google or somebody else may help and support us with this project.
![Page 69: A Practical Computer Program That Diagnoses Diseases In Actual Patients](https://reader033.fdocuments.in/reader033/viewer/2022042817/559cb4d31a28abed048b478d/html5/thumbnails/69.jpg)
WHAT NEXT?
Our diagnostic system, once implemented with all
known diseases and clinical data, is expected to
provide invaluable diagnostic benefits to patients,
physicians, nurses, health insurance companies,
malpractice lawyers, and the entire medical
establishment
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Thank you for your attention