Development
INTERNIST-I is the successor of the DIALOG system. For ten years, INTERNIST-I was the centerpiece of a Pittsburgh course entitled “The Logic of Problem-Solving in Clinical Diagnosis.” In consultation with faculty experts, much responsibility for data entry and updating of the system fell to the fourth-year medical students enrolled in the course. These students encoded the findings of standard clinicopathological reports. By 1982, the INTERNIST-I project represented fifteen person-years of work, and by some reports covered 70-80% of all the possible diagnoses in internal medicine. Data input into the system by operators included signs and symptoms, laboratory results, and other items of patient history. The principal investigators on INTERNIST-I did not follow other medical expert systems designers in adoptingUse of INTERNIST-I
By the late 1970s, INTERNIST-I was in experimental use as a consultant program and educational “quizmaster” at Presbyterian-University Hospital in Pittsburgh. INTERNIST-I’s designers hoped that the system could one day become useful in remote environments—rural areas, outer space, and foreign military bases, for instance—where experts were in short supply or unavailable. Still, physicians and paramedics wanting to use INTERNIST-I found the training period lengthy and the interface unwieldy. An average consultation with INTERNIST-I required about thirty to ninety minutes, too long for most clinics. To meet this challenge, researchers at nearbyINTERNIST-I and QMR
In the first version of INTERNIST-I (completed in 1974) the computer program “treated the physician as unable to solve a diagnostic problem,” or as a “passive observer” who merely performed data entry. Miller and his collaborators came to see this function as a liability in the 1980s, referring to INTERNIST-I derisively as an example of the outmoded “Greek Oracle” model for medicalSee also
*References
*Gregory Freiherr, The Seeds of Artificial Intelligence: SUMEX-AIM (NIH Publication 80-2071, Washington, D.C.: National Institutes of Health, Division of Research Resources, 1979). *Randolph A. Miller, et al., “INTERNIST-1: An Experimental Computer-Based Diagnostic Consultant for General Internal Medicine,” New England Journal of Medicine 307 (August 19, 1982): 468-76. *Jack D. Myers, “The Background of INTERNIST-I and QMR,” in A History of Medical Informatics, eds. Bruce I. Blum and Karen Duncan (New York: ACM Press, 1990), 427-33. *Jack D. Myers, et al., “INTERNIST: Can Artificial Intelligence Help?” in Clinical Decisions and Laboratory Use, eds. Donald P. Connelly, et al., (Minneapolis: University of Minnesota Press, 1982), 251-69. *Harry E. Pople, Jr., “Presentation of the INTERNIST System,” in Proceedings of the AIM Workshop (New Brunswick, N.J.: Rutgers University, 1976). *D. A. Wolfram, "An appraisal of INTERNIST-I," Artificial Intelligence in Medicine, 7, 2 (1995) 93–116External links