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First published March 28, 2003 as JAMIA PrePrint; doi:10.1197/jamia.M1184
Journal of the American Medical Informatics Association 2003;10(4):373-381
© 2003 American Medical Informatics Association

A more recent version of this article appeared on July 1, 2003
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Submitted on July 8, 2002
Accepted on February 23, 2003

Evaluation of a Cardiac Diagnostic Program in a Typical Clinical Setting

Hamish S. F. Fraser MBChB, MSc1*, William J. Long PhD2, and Shapur Naimi MD3

Affiliation of the authors: 1 Informatics Group, Childrens Hospital, Boston, MA; Clinical Decision Making Group, MIT Laboratory for Computer Science, Cambridge, MA; 2 Clinical Decision Making Group, MIT Laboratory for Computer Science, Cambridge, MA; 3 Division of Cardiology, Tufts-New England Medical Center, Boston, MA

* To whom correspondence should be addressed.

Context The Heart Disease Program (HDP) is a novel computerized diagnosis program incorporating a computer model of cardiovascular physiology. Physicians can enter standard clinical data and receive a differential diagnosis with explanations.

Objective To evaluate the diagnostic performance of the HDP and its usability by physicians in a typical clinical setting.

Design A prospective observational study of the HDP in use by physicians in departments of medicine and cardiology of a teaching hospital. Data came from 114 patients with a broad range of cardiac disorders, entered by six physicians.

Measurements Sensitivity, Specificity and Positive Predictive Value (PPV). Comprehensiveness: the proportion of Final Diagnoses suggested by the HDP or physicians for each case. Relevance: proportion of HDP or physicians diagnoses that are correct. Area under the ROC curve (AUC) for the HDP and the physicians. Performance was compared to a Final Diagnosis based on follow-up and further investigations.

Results Compared to the Final Diagnoses, the HDP had a higher sensitivity (53.0% vs. 34.8%) and significantly higher Comprehensiveness (57.2% vs. 39.5%, p<0.0001) than the physicians. Physicians' PPV and Relevance (56.2%, 56.0%) were higher than the HDP (25.4%, 28.1%). Combining the physicians and the HDP's diagnoses, sensitivity was 61.3% and Comprehensiveness 65.7%. These findings were significant in the two collection cohorts and for sub-analysis of the most serious diagnoses. AUC was similar for the HDP and the physicians.

Conclusion The heart disease program has the potential to improve the differential diagnoses of physicians in a typical clinical setting.




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