A Computational Model of Reasoning from the Clinical Literature

This article explores the premise that a formalized representation of empirical studies can play a central role in computer- based decision support. The specific motivations underlying this research include the following propositions: (1) Reasoning from experimental evidence contained in the clinical literature is central to the decisions physicians make in patient care. (2) A computational model based on a declarative representation for published reports of clinical studies can drive a computer program that selectively tailors knowledge of the clinical literature as it is applied to a particular case. (3) The development of such a computational model is an important first step toward filling a void in computer-based decision support systems. Furthermore, the model can help us better understand the general principles of reasoning from experimental evidence both in medicine and other domains. Roundsman is a developmental computer system that draws on structured representations of the clinical literature to critique plans for the management of primary breast cancer. Roundsman is able to produce patient-specific analyses of breast cancer-management options based on the 24 clinical studies currently encoded in its knowledge base. The Roundsman system is a first step in exploring how the computer can help bring a critical analysis of the relevant literature, structured around a particular patient and treatment decision, to the physician.