Effects of on-line symptom-processing on history-taking and diagnosis--a simulation study.

Techniques for computer-assisted diagnosis have been largely confined to off-line use, and there has been little examination of their potential role directly in the clinical setting. It is argued that the potential benefits of on-line diagnostic aids are considerable. A major barrier to such developments is uncertainty that the practical use of an on-line system would lead to the improvements in diagnostic effectiveness that more conventional off-line systems have already demonstrated. A series of studies in which clinicians took the histories of computer-simulated 'patients' presenting with dyspepsia, and formed diagnoses on the basis of these histories with and without computer assistance, suggested that diagnostic effectiveness may be greatly improved with on-line computer assistance. Some reasons for this improvement are discussed and it is concluded that the clinician and the on-line computer bring different but complementary types of knowledge to the diagnostic task. Though many practical questions remain to be answered the findings establish the principle of on-line symptom processing.