J Am Med Inform Assoc 1:8-27 doi:10.1136/jamia.1994.95236141
  • The Practice of Informatics
  • Review

Medical Diagnostic Decision Support Systems—Past, Present, And Future

A Threaded Bibliography and Brief Commentary

  1. Randolph A Miller
  1. Correspondence and reprints: Randolph A. Miller, MD, University of Pittsburgh, Medical Informatics Section, B50A Lothrop Hall, 190 Lothrop Street, Pittsburgh, PA 15261.


    Articles about medical diagnostic decision support (MDDS) systems often begin with a disclaimer such as, “despite many years of research and millions of dollars of expenditures on medical diagnostic systems, none is in widespread use at the present time.” While this statement remains true in the sense that no single diagnostic system is in widespread use, it is misleading with regard to the state of the art of these systems. Diagnostic systems, many simple and some complex, are now ubiquitous, and research on MDDS systems is growing. The nature of MDDS systems has diversified overtime. The prospects for adoption of large- scale diagnostic systems are better now than ever before, due to enthusiasm for implementation of the electronic medical record in academic, commercial, and primary care settings. Diagnostic decision support systems have become an established component of medical technology. This paper provides a review and a threaded bibliography for some of the important work on MDDS systems over the years from 1954 to 1993.


    • This paper was prepared in honor of Professor Shin-Ichi Shiina of tokyo Medical and Dental University. He became Professor Emeritus on April 9, 1993, after a long and productive career combining Clinical and Laboratory Medicine and Medical Informatics. He was among the earliest researchers in computerized ECG analysis, later developed a rule-based laboratory diagnostic system, and recently has pioneered use of optical cards for storing patient records in Japan. An earlier version of this manuscript was presented at a 1993 Symposium in Tokyo honoring Dr.Shiina.

      Supported in part by Grant R01-LM-04622 and by Contract N01-LM-1-3535 from the National Library of Medicine.

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