Critiquing based on automated medical records: An evaluation of HYPERCRITIC

Abstract

For some medical domains critiquing the decisions of a physician has been advocated as an appropriate approach inproviding decision support [1,2]. This notion of critiquing hinges on the observation that medical practice is characterized by both practice variation and subjective evaluation. Therefore, an objective standard for the ideal treatment is often not available. In the absence of such an objective standard, the critiquing approach advocates a discussion of the relative merits of a proposed treatment plan. This paper describes the evaluation HYPERCRITIC, a critiquing system that relies on data stored in computerized medical records for its input. The purpose of HYPERCRITIC is to offer comments to general practitioners (GPs) on their treatment of hypertension. HYPERCRITIC uses ELIAS, an automated ambulatory medical record facility designed for use by primary care physicians [3]. The automated medical record in ELIAS was designed for use in the routine data management functions in a primary care setting, it was not specifically designed to operate as a data-acquisition module for a knowledge-based decision-support system. HYPERCRITIC takes as input the electronic ELIAS medical record for a single patient. HYPERCRITIC will not request any additional data besides the data available in this medical record. HYPERCRITIC is activated by the presence of the diagnosis of hypertension in the medical record. For a more detailed description of the system see [4].