An expert consultation system for frontline health workers in primary eye care

Abstract

In developing countries, blindness is a major health problem whose control depends on the application of simple measures by frontline workers because, in many of these countries, specialist medical care is not readily available. To assist primary health workers in the management of common and potentially blinding eye disorders, we have developed a prototype computer program for a hand-held computer that incorporates a set of guidelines for diagnosis and treatment. This eye treatment program will help evaluate the potential of such devices for improving health care delivery in developing countries. This approach is now feasible because of recent advances in expert system and portable computer technology.

An Intelligent Computer-Assisted Instruction System Designed for Rural Health Workers in Developing Countries

“…Information sciences and computer technology have been frequently proposed as means for improving knowledge transfer to and within developing countries in the domains of public health, decision support, and education [3][4][5]. However, practical projects are relatively scarce [6][7][8][9][10][11].…”

“…Most of these systems are decisionsupport systems, essentially filter systems which help the user to decide whether a patient should be referred to a physician, designed for general practice [6], or for limited problems such as eye care [7] or childbirth [8]. Two systems, our previous work Tropicaid [9] and the Vie-Ket prototype [10], are knowledge-based systems with broad capabilities, including diagnostic and therapeutic advice.…”

Medical AI systems as appropriate technology for developing countries

“…Many people have criticized the use of flowcharts because they force an ordering on gathering information (e.g. Kastner et al, 1984) although others have used precisely this feature as an asset, suggesting that it encourages systematic history taking. Others criticize the strict path on the grounds that it does not correspond to the "hypothesize and test" method of diagnosis (Auvert et al, 1986b).…”

“…It is also based on a very small subdomain of medicine. Kastner et al (1984) and Ostroff et al (1986) developed a small, simple system for primary eye care, again acting as a filter system for referrals to secondary health centres, again designed for eventual use of a hand-held machine. The system was implemented in a rule based shell (EXPERT).…”

“…The rule sequences that lead to the desired expert performance can then be translated into a decision algorithm." (Kastner et al, 1984) language: BASIC architecture: rule based interface: numerical, yes/no, checklist and multiple choice questions development machine/environment: rule-based shell, EXPERT, developed on Vax and Dec mainframes delivery machine: Apple He and Epson HX20 testing: tested with hypothetical cases and real ones collected from California and Yemen. To be trialed in Tunisia by public health nurses and primary physicians, and in Egypt by primary care physicians.…”