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The Beginning of Expert Systems for Medical Diagnosis (July 3, 1959)


"Reasoning Foundations of Medical Diagnosis," by Robert S. Ledley and Lee B. Lusted published in Science, 130, No. 3366, 9-21, on July 3, 1959 represented the beginning of the development of clinical decision support systems (CDSS) — interactive computer programs, or expert systems, designed to assist physicians and other health professionals with decision making tasks.

"Areas covered included: symbolic logicBayes’ theorem (probability), and value theory. In the article, physicians were instructed how to create diagnostic databases using edge-notched cards to prepare for a time when they would have the opportunity to enter their data into electronic computers for analysis. Ledley and Lusted expressed hope that by harnessing computers, much of physicians’ work would become automated and that many human errors could therefore be avoided.

"Within medicine, Ledley and Lusted’s article has remained influential for decades, especially within the field of medical decision making. Among its most enthusiastic readers was cardiologist Homer R. Warner, who emulated Ledley and Lusted’s methods at his research clinic at LDS Hospital in Utah. Warner’s work, in turn, shaped many of the practices and priorities of the heavily computerized Intermountain Healthcare, Inc., which was in 2009 portrayed by the Obama administration as an exemplary model of a healthcare system that provided high-quality and low-cost care.

"The article also brought national media attention to Ledley and Lusted’s work. Articles about the work of the two men ran in several major US newspapers. A small demonstration device Ledley built to show how electronic diagnosis would work was described in the New York World Telegram as a “A Metal Brain for Diagnosis,” while the New York Post ran a headline: “Dr. Univac Wanted in Surgery.” On several occasions, Ledley and Lusted explained to journalists that they believed that computers would aid physicians rather than replace them, and that the process of introducing computers to medicine would be very challenging due to the non-quantitative nature of much medical information. They also envisioned, years before the development of ARPANET, a national network of medical computers that would allow healthcare providers to create a nationally-accessible medical record for each American and would allow rapid mass data analysis as information was gathered by individual clinics and sent to regional and national computer centers" (Wikipedia article on Robert Ledley, accessed 05-03-2014.)

(This entry was last revised on 05-03-2014.)