Electronic Medical Record and Expert Systems
Medical knowledge and expertise are the most important patrimony of a medical institution in terms of results (better diagnosis, better treatment, better teaching) and in terms of efficiency (less mistakes, shorter time, lower economical and social costs)
Knowledge and expertise are always been transmitted by teaching and books, but this is not always the most efficient way: a great part of individual expertise goes away when the expert quits the job. An "accumulation of knowledge" could be one of the best investments for an institution and will certainly be much more so in the future.
Computer programs called "Expert Systems" (ES) are developed to contain and use knowledge from human experts.
The EMG lab has used an ES, called "Elektro" for daily clinical work since 1991. Elektro is a component of an Electronic Medical Record (EMR) called "Euristic". Each EMG report is generated for about 90 percent by the ES.
By year 2004 the EMG Lab archive contains about 25,000 cases and is used for clinical work, research and teaching.
The EMG Lab focuses on formalization and engineering of neurological knowledge and expertise. Programming is done externally.
Main Features of the Expert System
In the ES, neurological knowledge is represented as concepts and Rules. Examples of concepts are the muscles, the nerves, the test parameters, the normal and abnormal values of tests, the name of diseases and of physiopathological states.
An ES that operates in a real clinical environment (not as an academic demonstration) must contain a significant amount of knowledge. Elektro contains about 800 neurological concepts and more than 1,000 rules. Rules are made by several conditions that operate directly on patient data or, more frequently, on results generated by other rules. At present the ES contains about 4,000 rule conditions.
Use of the Expert System
Diagnostic Support and Report Generation
In the daily routine, once the clinical data have been introduced in the EMR, the ES generates a report for EMG, Nerve Conduction, RNS and the other techniques used, together with neurological exam and history. Each section contains the raw data and several stages of processing with a natural language description of data and their interpretation. Starting from the results of the different sections, a final impression if generated, in order to reach a clinical level. The report is then modified or completed by the user and finally printed and archived in the EMR
Teaching: Rules Justification, Neurological Reasoning, "What If" Interrogations
The ES reasoning is fully justified, so a resident can learn the mental process that drives the several steps between data and final impression. The user can easily see why a certain conclusion has been excluded and can also see which ones comes close to be considered true.
As a further step in a clinical database, The EMG Lab archive contains not only the raw data (several hundreds of individual data per examination) but also the results of the ES in terms of concepts found true in that particular case. At present more than 500,000 concepts are archived for about 25,000 cases studied (Fall 2004). This allows statistical analysis on raw data and concepts together. This analysis is very important for the continuous tuning and updating of the neurological knowledge in the ES.