Appropriateness and necessity research on the Internet: Using a "second opinion system"

Appropriateness and necessity research of various procedures in medicine ma y be the most complex field of innovation in healthcare and technology asse ssment. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal q uality components of structures, processes and outcomes become irrelevant w ithout a proper indication. The first part of our appropriateness initiativ e in interventional cardiology and gynecology was to formulate guidelines. To define the appropriateness for coronary angiography, coronary revascular ization and hysterectomy, literature-based consensus methods were used. The second part was to disseminate the guidelines in a user-friendly manner vi a the Internet. Therefore, we relied on a system-driven query facility for propositional (experts) rules. The next part of the appropriateness initiat ive may be a user-friendly Internet-based data collection system to validat e the national accepted guidelines, Most important may be that only data th at is needed can be collected using a refined data base technology. The des cribed Second Opinion System can be found under: http://sos.inf.ethz.ch. Re search on indications with data on clinical outcome may open new opportunit ies to validate indication guidelines using Internet/database technology fo r data analysis and browsing of decision graphs concerning clinical decisio n-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes.