The goal is to develop a knowledge-based expert management system to deliver cost-effective quality medical care. This system will allow health care providers to plan and allocate services within the existing budgeting and economic constraints. The methodology consists of 1) building an integrated database of clinical and management information, 2) designing the knowledge representation used in the expert system, 3) using induction to extract data relationships from the database, and 4) building an expert system based on these relationships and rules obtained from medical experts. The expected results are documented standards of care and treatment protocols for the specialty practice chosen and a system to monitor adherence to these standards and protocols. In Phase 11, we will expand the expert system to include other physician specialties, and we will design physician workstations to allow online preauthorization of costly or risky services. This system will incorporate the latest computer technologies including artificial intelligence, knowledge-based expert systems, CD ROM storage, speech recognition and imaging. The resulting system will be a useful planning and monitoring tool for providers, third-party payers and government agencies.Awardee's statement of the potential commercial applications of the research: Potential commercial applications include use for planning and allocating medical care and services and devising and monitoring standards of care and monitoring utilization of services. Such a system would be useful to any major provider of health care services seeking to deliver cost-effective, quality care within the constraints of current reimbursement trends and limitations. These would include hospitals, HMO's, PPo's, clinical practice groups, corporate health benefit plans and union health and welfare funds. This system could also be used by payers of services such as insurance companies or government agencies to monitor participants in their programs.National Cancer Institute (NCI)
