The Center for Biomedical Informatics
State University of Campinas, Brazil

Research Abstracts

By means of structuring the logic reasoning that precedes or is part of the great majority of diagnostic and therapeutic proceduresin medicine, it is possible to build a clinical flowchart, which is a set of signs and symptoms, procedures, diagnosis and treatments, located inside frames which are linked together by flow lines satisfying or not a given condition. Thus, flowcharts are a kind of medical decision aid, easy to build, to understand and to use. Flowcharts are commonplace in medical textbooks and journals, and are readily accepted by physicians, in opposition to other AI formalisms, such as production rules. Furthermore, they usually are a good way to represent medical knowledge by means of directed acyclic or cyclic binary graphs, which can be easily traversed using a simple computer program. We describe here a microcomputer program, named SmartBase. which can be used to implement two basic aspects of clinical flowcharting: 1) producing computer-based representation of a clinical flowchart, including its text (frames) an conditional and inconditional branches (decision tree); 2) accomplishing user-directed decision making based some flow diagram produced by this mean, through direct interaction (question-and-answer on-line dialogue). In the first function, from a diagram previously designed by a physician, or extracted from some other reference source, the program is used to type in the text which is inside the frames, and arrange them into a directed decision graph. Frames are classified according to three main information types: "Q" (a question),"I" (complementary information, such as a box relating therapeutic procedures to be followed) and "E" (endframe, which signals the flowchart's final step). If the kind of frame is a question, the program accepts two possible answers (i.e. "yes" or "no"), which are linked to other diagram frame numbers in a particular window. In the second function, used for decision support, everything the user has to do is to "navigate" throughout the system, reading the boxes as they appear in colored windows onto the screen, striking any key, like arrows, or a specific letter in the keyboard, to search for some clinical procedures or diagnosis and treatment, or to follow the decision graph.e. The system is quite user-friendly and easy to program and to use, even by healthcare professionals without previous computer training. SmartBase was developed with a DBMS language (Clipper, Nantucket Corp., USA), and can be executed under the MS-DOS or PC-DOS perating systems, in IBM-PC-compatible microcomputers. In our institution, we have been using SmartBase to implement dozens of diagnostic and patient management flowcharts, mainly for teaching purposes, in several areas of clinical medicine. The program is available on demand from the author.

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Last Updated: March 2, 1996

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