Internet-based decision support for evidence-based medicine

The Protocol Assistant is a knowledge-based system, developed by the Department of Artificial Intelligence and AIAI at the University of Edinburgh, which advises on the treatment of parotid tumours. It has been developed to support both adherence to a clinical protocol based on the latest evidence and the use of clinical judgment where the evidence is weak or inconsistent. It was developed using a knowledge modelling technique named PROforma, which is specifically designed for representing best practice guidelines; the PROforma models were used as the basis for a user interface, which was implemented in HTML. A set of rules were developed in JESS (the Java Expert System Shell) which were capable of “running” the protocol; a simple method of reasoning with certainties, based on the “goodness” of each relevant item of published evidence, was used to recommend which path to follow at choice points. However, the user is also supplied with access to the abstracts of all relevant published articles, using the hypertext facilities of HTML. The Protocol Assistant can thus be used either as a “wizard” which guides users through the decision making process, or as a “hypertext manual” which leads them to the information relevant to the decision they are making. This dual-role capability is crucial for the acceptance of KBS in the real world.