Display for Medical Procedure Selection

Abstract

This paper presents a novel approach for displaying medical procedure options to care providers when selecting the next appropriate diagnostic test or therapeutic procedure to order for a patient. This approach works in the same way that care providers perform medical reasoning by presenting options based on the information the care provider hopes to gain from the test or the desired result of the treatment. The method for implementing this approach is described briefly.

Problem

Clinical decision support systems (CDSSs) typically recommend next tests or procedures based on a set of rules [1]. These systems do not operate in the same way that care providers perform medical reasoning, which can impede clinical workflow, or even be counterproductive [2]. Incompatibility with workflow can also lead to the rejection of a CDSS [1].

In some cases, the care provider knows what type of information he/she would like from, e.g., a diagnostic test, but is not sure which test is best to discover this information for this specific patient. For example, a clinician tackles a problem from the point of view, “I want to know the extent of myocardial ischemia. Which tests will provide this information?” On the other hand, decision support systems are focused on strictly following guidelines or rules, which are aimed at the average patient and as such can be ambiguous. Clinical guidelines simply list all tests available for treating the condition at each stage of the guideline, leaving it to the clinician to recall what information each test provides. For experts, this is not a problem. However, for subexperts (seasoned physicians working outside their own specialty area), this can be difficult because they are not exposed to this information on a regular basis [2]. The value of this approach is that such knowledge would also empower the referring care provider when interacting with specialists.

Solution

Presenting diagnostic test or therapeutic procedure options based on the information that the care provider hopes to discover from the test, e.g., extent of myocardial ischemia, or achieve from the treatment, e.g., increase cardiac output, may assist clinicians in making better clinical decisions. In addition, the system will present the care provider with general and patient-specific data about the procedure to assist in the selection of the optimal procedure for the current patient. The final decision is left to the care provider to make.

Implementation

The care provider is presented with a list of information items they may desire that is relevant to the patient’s signs, symptoms and medical history, or they may use a free-form text box to describe the information they are looking for. The system presents options that provide the desired information or achieve the therapeutic goal. In addition, the system provides procedure-specific information such as invasiveness, risks, contraindications, limitations (e.g., for certain patient groups like diabetics), sensitivity and specificity statistics for a patient population with similar characteristics to the current patient, cost, reimbursement, time required to perform the test, earliest possible time to receive results, etc. to assist in the selection of the most appropriate procedure. Finally, the care provider is given the opportunity to evaluate this information and select the appropriate procedure for the patient.

The system will contain a “result” database that associates desired results to a code, which in turn is linked to a “procedure” database including the names of the various procedures, associated result codes indicating what outcomes result from the procedure, possible contraindications for a patient, the cost associated with the procedure, a location where the procedure is to be performed, etc. This information will be compared to the patient’s profile to customize aspects of the procedures, if necessary.

Discussion

This approach for displaying medical procedure options may help to integrate molecular imaging and molecular medicine into clinical practice in the future. Most care providers are unaware of the expanding applications associated with these fields, and will continue to use only conventional approaches for many years to come. A system that can introduce these new options in a non-threatening manner alongside conventional technologies may assist with the faster integration of these technologies into regular clinical practice.