DXplain is a

Clinical decision support system A clinical decision support system (CDSS) is a health information technology, provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, to help health and health care. CDSS encompasses a variety of ...

(CDSS) available through the

World Wide Web The World Wide Web (WWW), commonly known as the Web, is an information system enabling documents and other web resources to be accessed over the Internet. Documents and downloadable media are made available to the network through web ...

that assists

clinic A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs ...

ians by generating stratified diagnoses based on user input of patient signs and symptoms, laboratory results, and other clinical findings. Evidential support for each

differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

is presented, along with recommended follow-up that may be conducted by the clinician to arrive at a more definitive

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...

. The system also serves as a clinician reference with a searchable

database In computing, a database is an organized collection of data stored and accessed electronically. Small databases can be stored on a file system, while large databases are hosted on computer clusters or cloud storage. The design of databases ...

of diseases and clinical manifestations.

History

Massachusetts General Hospital Massachusetts General Hospital (Mass General or MGH) is the original and largest teaching hospital of Harvard Medical School located in the West End neighborhood of Boston, Massachusetts. It is the third oldest general hospital in the United Stat ...

, work on DXplain began in 1984 with a first version being released in 1986.

Educational tool

Use of DXplain as a tool for medical consultation has been common to some institutions since it fills a gap, particularly for

medical student A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, MB ...

s in clinical rotations, that is not adequately covered by textbook literature. The system's large knowledge base combined with its ability to formulate diagnostic hypotheses have made it a popular education tool for US-based medical schools; by 2005, DXplain was supporting more than 33,189 total users.

Methodology

DXplain generates ranked differential diagnoses using a pseudo-probabilistic

algorithm In mathematics and computer science, an algorithm () is a finite sequence of rigorous instructions, typically used to solve a class of specific problems or to perform a computation. Algorithms are used as specifications for performing ...

. Each clinical finding entered into DXplain is assessed by determining the importance of the finding and how strongly the finding supports a given diagnosis for each disease in the

knowledge base A knowledge base (KB) is a technology used to store complex structured and unstructured information used by a computer system. The initial use of the term was in connection with expert systems, which were the first knowledge-based systems. ...

. Using this criterion, DXplain generates ranked differential diagnoses with the most likely diseases yielding the lowest rank. Using stored information regarding each disease’s prevalence and significance, the system differentiates between common and rare diseases.

Accuracy

Analysis of accuracy has shown promise in DXplain and similar clinical decision support systems. In a preliminary trial investigation of 46 benchmark cases with a variety of diseases and clinical manifestations, the ranked differential diagnoses generated by DXplain were shown to be in alignment with a panel of five board-certified physicians. In another study investigating how well decision support systems work at responding to a

bioterrorism Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, insects, fungi, and/or toxins, and may be in a naturally occurring or a human-modified form, in much the same ...

event, an evaluation of 103 consecutive internal medicine cases showed that Dxplain correctly identified the diagnosis in 73% of cases, with the correct diagnosis averaging a rank of 10.7.

Clinical usage

Despite its usage in clinician training, similar to other clinical decision support systems, DXplain has not expanded beyond the research laboratory or medical training setting, due in part to a lack of support by

clinicians A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for pat ...

in real-world settings.Coiera E. Guide to Health Informatics: 2nd Edition. Arnold, 2003; 332-343.

References

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External links

DXplain at the MGH Lab of Computer Science
Medical expert systems Medical software