DOCLE SYSTEMS
MEDICAL SPREADSHEET
the very
near future, your medical consultation will probably be modulated by a piece of
software that will be as indispensable to the doctor as the number spreadsheet
is to the accountant. We have finally caught up with Dan Bricklin (of Visicalc
fame, the forerunner of the accounting spreadsheet that launched the Apple II
microcomputer) and Carolus Linneas (Swedish scientist who founded the Linnean
classification system that gave us species names such as Homo sapiens in the
1750s). A new class of software called the PLUM Medical Spreadsheet® (patent
pending) was demonstrated at the Royal Australian College of General Practioner
(RACGP) Computer Conference, Melbourne Convention Centre, August 7-9, 1997 and
the subsequent international Asia Pacific Association for Medical Informatics
(APAMI) 97 Conference in the Darling Harbour Convention Centre, Sydney,
Australia on August 10 -13, 1997. PLUM is a combination of the power of the
iterative problem solving method, characteristic of the spreadsheet, and a
medical belief system constructed along the lines of the Linnean biological
system. The PLUM name is an acronym for Presentation Links Unity and
Management, which is the health model used in the medical spreadsheet.
The typical accounting
spreadsheet is a number cruncher and gives the accountant quick answers to
"What if?" type queries. The results of this "What if?"
analysis are placed in the spreadsheet cells; this sets up the conditions for
the next round of calculations with no manual transcription. The accountant's
electronic spreadsheet is prodigious for tasks that require repetitive work
with a hand held calculator. Hitherto, there is no such equivalent spreadsheet
in either the medical or legal domains. With PLUM, during a client encounter,
there is the capability of :
|
|
allowing data
entry and recording
|
|
|
performing
"What if?" calculations pertaining to client diagnosis and management,
with the results placed in cells for the next round of evaluation and
|
|
|
features such
as scrollable worksheets which can be saved.
|
is used in a
real or simulated patient or client encounter environment which introduces the
spreadsheet metaphor into clinical medicine. There were at least two main
barriers that needed to be surmounted to attain such an invention. The first
was coming up with a replacement for the number system used in conventional
spreadsheets. PLUM uses a word-based coding and medical belief system modelled
on the Linnean classification. In this system a medical condition such as gout
is a medical species with its own phyllum, class, order, family and genus.
Surmounting the second barrier was finding a suitable homogenous clinical data
model of patient health status at the local encounter and the global level.
Typical queries, out of a theoretical set of 225, operating on the medical
spreadsheet would be:
|
|
given symptoms
and signs, show possible diagnoses
|
|
|
given a set of
possible diagnoses, symptoms, signs and laboratory test results, show only
diagnoses that conform to available data
|
|
|
given a list
of diagnoses, show diagnosis that can unite several diagnoses.
|
Systems
stumbled onto the PLUM Medical Spreadsheet almost by default. It is the
originator of the Linnean Docle medical coding system used by over 2000 medical
practitioners Australia-wide. It was the congruent classification of disease
entities, akin to the building of a belief system framework that allowed the
medical belief system to be viewed using the spreadsheet metaphor.
PLUM is relevant to any
problem domain where the problem solver needs to arrive at a diagnosis given a
set of indeterminate data. The knowledge domain that almost mimics the medical
domain is the legal field, and an equivalent theory for legal problem solving
in the spreadsheet form also exists. PLUM represents a new class of software -
non-numerical spreadsheets and a new model of medical recording. There is a
stark message to doctors - modern day medical practice is being swamped with
information overload arising from the advances in medical technology. The
medical litigation arising from the failure to cope with this plethora of
information is ugly. The Information Technology solution is to well, go for
PLUM or....... choke on SOAP (the existing clinical model which stands for
Subjective Objective Assessment Plan). PLUM is in advanced beta, a subscription
service is now available for those wanting to immerse themselves in the
forefront of medical computing.
Plum
Medical Spreadsheet®, Plum® and Docle® are registered or pending trademarks.
© Docle Systems 1997