Internet-based decision support for evidence-based medicine

The Protocol Assistant is a knowledge-based system, developed by the Depart ment of Artificial Intelligence and AIAI at the University of Edinburgh, wh ich advises on the treatment of parotid rumours. It has been developed to s upport both adherence to a clinical protocol based on the latest evidence a nd the use of clinical judgment where the evidence is weak or inconsistent. It was developed using a knowledge modelling technique named PROforma, whi ch is specifically designed for representing best practice guidelines; the PROforma models were used as the basis for a user interface, which was impl emented in HTML. A set of rules were developed in JESS (the Java Expert Sys tem 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. T he Protocol Assistant can thus be used either as a "wizard" which guides us ers through the decision making process, or as a "hypertext manual" which l eads 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 worl d. (C) 1999 Elsevier Science B.V. All rights reserved.