<i>Internist-I</i>, an Experimental Computer-Based Diagnostic Consultant for General Internal Medicine

TLDR

INTERNIST‑I is an experimental computer program capable of making multiple and complex diagnoses in internal medicine, and it differs from most other computer‑assisted diagnosis programs by its generality and the size and diversity of its knowledge base. The study aimed to document INTERNIST‑I's strengths and weaknesses. We performed a systematic evaluation of the program's capabilities. The evaluation on 19 clinicopathological exercises showed performance comparable to hospital clinicians but inferior to case discussants, and revealed deficiencies such as lack of anatomical or temporal reasoning, limited differential diagnosis across problem areas, incorrect attribution of findings, and inability to explain its reasoning, rendering the program unreliable for clinical use. Citation: N Engl J Med.

Abstract

Abstract INTERNIST-I is an experimental computer program capable of making multiple and complex diagnoses in internal medicine. It differs from most other programs for computer-assisted diagnosis in the generality of its approach and the size and diversity of its knowledge base. To document the strengths and weaknesses of the program we performed a systematic evaluation of the capabilities of INTERNIST-I. Its performance on a series of 19 clinicopathological exercises (Case Records of the Massachusetts General Hospital) published in the Journal appeared qualitatively similar to that of the hospital clinicians but inferior to that of the case discussants. The evaluation demonstrated that the present form of the program is not sufficiently reliable for clinical applications. Specific deficiencies that must be overcome include the program's inability to reason anatomically or temporally, its inability to construct differential diagnoses spanning multiple problem areas, its occasional attribution of findings to improper causes, and its inability to explain its "thinking." (N Engl J Med. 1982; 307:468–76.)