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Medical Expert Systems - Martin Sturman
Medical Expert Systems - Martin Sturman

Martin Sturman
Martin F. Sturman, MD, FACP - Dr. Sturman who began work in expert medical systems in 1983, founded MatheMEDics in 1987. In the past 2 years the MatheMEDics group has concentrated on process and redesign optimization programs for managed care entities and clinical diagnostic software. Focus has for the past year been on browser-accessible interactive web sites on the Internet. Dr. Sturman brings over 38 years health care experience to his company, including 36 years clinical practice in internal medicine and medical imaging, and 2 years as an HMO medical director.

He completed his medical training at The London Hospital and at Temple University School of Medicine, and subsequently was a Visiting Investigator and Assistant Physician at Rockefeller University where he did research in fat metabolism.

Dr. Sturman practiced internal medicine and endocrinology for 8 years in New York City where he was on the staff of Lenox Hill Hospital. He subsequently practiced 7 years in Connecticut, where he was Chief of Endocrinology at the Bridgeport Hospital. Prior to 1973 when he left practice to attend the University of Michigan Medical Center as a National Cancer Institute Trainee and Fellow in Nuclear Medicine, he was Assistant Professor of Radiology and Associate Director of the Radioisotope laboratory at the Yale University School of Medicine.

In 1974 Dr. Sturman was appointed Director Department of Nuclear Medicine at St. Michael's Medical Center, a 400-bed teaching hospital in Newark, NJ. Two years later he established the Department of Ultrasonography at St. Michael's. In 1993 Dr. Sturman's textbook, Effective Medical Imaging: A Signs and Symptoms Approach was published by Williams and Wilkins.

Since 1993 Dr. Sturman, in addition to his work with MatheMEDics, was a consultant in medical software, did medical writing, and had been a Medical Director at two major Philadelphia health plans before leaving to devote his full time efforts to MatheMedics. He is the author of 18 scientific papers and holds several U.S. patents on a safety needle licensed to a major international corporation.

Dr. Sturman who is Board Certified in Internal Medicine and in Nuclear Medicine is a member of The Endocrine Society and a Fellow of the American College of Physicians. He holds a Bachelor of Science degree from the University of Chicago and received his M.D. degree from the State University of New York Upstate Medical Center at Syracuse.

HealthBond has been given the opportunity to display this product to our members. We have attached a discussion on EasyDiagnosis. Please communicate whether you like it, would use it, or how to improve it. MatheMedics is interested in your feedback. Click Here

Question 1 - What is an "Expert System"? Is it a form of Artificial Intelligence? by HBInterview on August 14, 2000

Answer 1 - Yes, expert systems are really a branch of Artificial Intelligence or "AI" which also includes robotics, natural language processing, and other applications. Such systems can be defined as the collection of hardware, software, data, and knowledge needed to develop computer systems and machines that demonstrate characteristics of intelligence. Without going into more detail, I will evade the problems of defining "intelligence."

We are provided a futuristic glimpse into AI with science fiction and computer systems such as HAL in 2001: A Space Odyssey. While HAL is fictional, the use of intelligent systems has been explored for more than 50 years. Beginning with embedding human expertise in computer programs for geological exploration, and ending today in control devices on consumer appliances, we see applications of AI and expert systems permeating every aspect of our lives. by Martin Sturman on August 14, 2000
Question 2 - Tell us how you became involved in technology and expert systems at a time when very few people in the healthcare industry was focused on this area especially physicians. by HBInterview on August 14, 2000

Answer 2 - My interest in "high tech" goes back to the early days of nuclear medicine when iodine metabolism was virtually the first application of radionuclides to clinical medicine and I-131 was first used for thyroid diagnosis and treatment. Several years later I decided to enter nuclear medicine full time and found computer applications to imaging were aleady being pioneered at the Univ. of Michigan where I had been accepted for my second residency. From then on I was hooked on computers and the medical application of software. It was an easy step a few years later to enter the field of expert systems, the broad application of computer knowledge to clinical problems. I was indeed fortunate in my involvement early in the game, several years after expert systems had been developed for other fields, long before they had become of general interest to non-technical physicians. by Martin Sturman on August 14, 2000
Question 3 - Can you give examples of Expert Systems? by HBInterview on August 14, 2000

Answser 3 - These are almost endless. Expert systems have been used By Mercedes Benz and other auto manufacturers in the design of vehicle components, subway systems in Sendai, Japan and Washington, D.C. use expert system software controllers to cause subway trains to stop within 3 inches of the right spot on the platform. Motormen exist primarily to reassure passengers. "Fuzzy logic" controllers are used in refrigerators, washers, dryers, anti-lock brakes, sensors, security systems, and a wide variety of consumer electronics. In the medical area, at least one hospital has studied the use of expert system analysis in estimating the optimal length of stay for a given patient. And, of course, expert systems of various types have been studied for application to decision-making in medical diagnosis and treatment. by Martin Sturman on August 14, 2000
Question 4 - Dear Dr. Sturman - Who do you see using this first? by dogbooks on August 14, 2000

Answer 4 - Consumers, managed care, hospitals, and the entire health care industry. We believe it will picked up first by managed care entities at financial risk and hospitals who need the benefits of this technology most urgently. by Martin Sturman on August 14, 2000
Question 5 - Expert Systems have the ability to "learn". Could you explain what is meant by "learn"? by HBInterview on August 15, 2000

Answer 5 - I am guilty of the common error of comparing computers with people,-anthropomorphizing. What I meant was computers can indeed improve their performance with experience, emulating human beings. They can be programmed to do this by incorporating stored outcomes (perfect cases), and subsituting these verified results automatically into their previously-stored code. In this way the more "correct" answers yielded by testing in the real world the more the stored program improves its own performance. by Martin Sturman on August 15, 2000
Question 6 - Is there some reluctance on our part to embrace this technology in healthcare because of the learning capability and potential to be better than humans? to lose our jobs? to be to dependent on computers? Any thoughts? by HBInterview on August 15, 2000

Answer 6 - Very good question. Whild it is true some people distrust the entire idea of machine "intelligence" possibly because of insecurity or misunderstanding, it is helpful to grasp the idea that computers are, in a very real sense, stupid. By that I mean, computer programs exist only because human beings created them. They only do what we tell them. By themselves computers, by which I mean both hardware, but particularly software, are nothing more or LESS than what we make of them or how we use them. If computers, and especially computer programs are badly made or poorly used it is our fault, not the fault of the technology. There are many examples of bad use of computers. A few years ago a poorly designed jumbo jet (not a Boeing) crashed outside of Paris, killing over 300 people. The reason for the crash
was that the pilot could not override a malfunctioning computer. Luckily, this no longer can happen. by Martin Sturman on August 15, 2000
Question 7 - How are Expert Systems being used in Healthcare? Practices? Hospitals? Payers?...etc? by HBInterview on August 15, 2000

Answer 7 - Unless you include the use of voice mail-one of the simplest form of expert system, very few, if any true expert systems are in use in health care, hospitals, practices, or by payers. Database management software has been the mainstay of health care, not decision support. There are many deterministic flow charts described as "algorithms" or rule-based recipes, and some of these have been put to good use over the years, for example in triage, but in fact they are too obvious and similar to voice mail to be described as true expert systems. Some ambitious clinical programs for physician have and are being developed by major academic institutions such as Harvard, MIT, The Univ.of Oklahoma, other schools,and the Government, but what we have seen on the Web are time-consuming, formidable programs requiring extensive input, and are devoted to mechanisms and explations of how how diagnoses are reached, but not primarily to symptom presentations. Many of these programs are interesting academically, and I would be glad to point visitors to some of web sites if they would contact me. by Martin Sturman on August 15, 2000
Question 8 - Can Expert Systems in Healthcare be adapted for use by laymen (i.e. patients)? by vrijh on August 16, 2000

Answer 8 - Yes,expert systems like ours giving information and estimated probabilities of conditions based on symptoms can be of great interest and practical use in education of laymen. However, as we emphasize repeatedly in our disclaimers for both consumer and professional versions of our software, expert systems used in this manner are only a special form of test. THEY ARE NOT A SUBSTITUTE FOR CLINICAL JUDGMENT OR A VISIT TO THE PHYSICIAN. At the same time symptom-based programs by matching a complaint with a disease can be much more "user friendly" and practical than programs attempting to match a long list of diseases with the patients'problem. by Martin Sturman on August 16, 2000
Question 9 - Have the proposed HIPAA regulations affected the development or acceptance of AI and the Internet in general in the medical community? by HBInterview on August 16, 2000

Answer 9 - The Health Insurance Portability and Accountability Act protects health insurance coverage for workers and their families when they change or lose their jobs. As expert systems and database management functions become more widespread on a web-based platform,patients as well as health plans can only benefit from their availability. by Martin Sturman on August 16, 2000

Answer 9 - I neglected to do my homework on the latest amendment to the HIPAA Act which became final in March of this year. This deals, as your question suggests, with electronic privacy and the confidentiality of medical records. These HHS regulations were mandated by Congress to take place if Congress failed (as indeed it did) to pass national privacy legislation to protect against inappropriate use of individually identifiable health information. These regulations should have a helpful impact on provider groups and health plans on the Internet, but in my opinion do not alter the requirement of ANY expert system to protect patient privacy. The only problems will be the result of any convoluted legislation regulating the communications, especially the Internet: confusion, overregulation, and an explosion of liability claims against health plans, privacy on the Internet. by Martin Sturman on August 16, 2000
Question 10 - You use the term "fuzzy logic". What does this mean? by HBInterview on August 16, 2000

Answer 10 - Fuzzy logic compared to "normal" logic is a matter of shades of gray, not "yes" or "no." That's why simple decision trees are becoming outmoded. If our reasoning has logic,in the real world it's fuzzy at best. Fuzzy logic helps machines manage these problems that are not answerable by a simple choice. Computers can be made that emulate the uncertainty of human decision-making. The easy world of symbolic reasoning in "artificial intelligence" is over, to be replaced by learning systems, neural networks, and other technologies that some day will approach "Terminator I" and Arnold Schwazenneger. by Martin Sturman on August 16, 2000
Question 11 - Why is there not many expert systems used in healthcare? Are we lagging behind in technology? OR is there another reason? by HBInterview on August 16, 2000

Answer 11 There's no question that the medical profession and health care management have historically lagged behind industry in the use of expert systems and decision support. The technology has been there for 50 years, but unfortunately the emphasis has been on database management functions in administration, such as billing, demographics, etc. The application of expert systems has been overlooked; it's much easier to construct and interrogate data-bases than to conceptualize decision support applications. This is going to change-but only under the pressure of cost containment. by Martin Sturman on August 16, 2000
Question 12 - What are the legal ramifications of using expert systems and decision support software? by HBInterview on August 16, 2000

Answer 12 - Federal law requires FDA approval of all expert systems and other software and hardware incorporated in any type of device interfaced with a human patient, for example X-ray timers, imaging software used in MRI, CT, and nuclear medicine equipment, monitors, respirators, etc. There is no legislation encroaching on the use of purely intellectual tools as exemplified in diagnostic or optimization software, although vague threats have been issued in the past. First amendment rights would seem to prevent FDA interference with software functioning in the realm of creative thought which should be compared with books, manuals, and other printed material.

Of course, no law can prevent anyone from suing anyone else for anything from defamation to product liability. The only defense involves the use of carefully worded disclaimers on which we depend extensively. by Martin Sturman on August 16, 2000
Question 13 - Can you give specifics on what you think the benefits and savings are/could be when using expert systems in this industry? by HBInterview on August 17, 2000

Answer 13 - Based on analysis of various health plans, we estimate impressive savings on 5 CPT codes for CT/MRI imaging ALONE. Using expert system software interactive on an Internet platform could save over $150,000 per month for a 100,000 member health plan. This does not include estimated savings on other diagnostic services, administration,etc. Hospitals, moreover, lose millions on in-patient studies for which they are not reimbursed underDRG's or per diems, studies which could provide revenue if done as outpatients. Again, expert system software would identify and help audit these situations. There are other potential savings that could be facilitated by using expert system software, customized for a variety of decision-making tasks, both administrative and clinical in almost all health care settings: Employers, plans, hospitals, ER's, the provider's office, etc. Applications of expert systems in optimization strategies for contracting,reimbursement, billing, etc. have hardly been considered by the health care industry. by Martin Sturman on August 17, 2000
Question 14 - What might be the downside to using expert systems? and Could you share with the members some tricks of the trade you have learned when dealing with expert system technology? What to avoid if possible? by HBInterview on August 17, 2000

Answer 14 - Expert systems, like all technology, can be misused, but if this happens it is Never the fault of the technology, but the fault of ourselves. Recipes for disaster include, among other thinks, failures in upgrading decision-making software lack of attention to bugs, neglecting the user interface, especially ability to override certain decisions-the list is endless. Patient privacy issues on the Internet, as elsewhere, remains an overriding issue in health care, but this is not case specific for expert systems. In the design of such systems it is essential to work closely with the users themselves in all stages of development. It is not enough to hand over the problem, as is often done, to the computer programmer. Moreover, this continued collaboration between designer and user must never cease, even after development, because expert systems to an even greater extent than database software are living, evolving organisms. by Martin Sturman on August 17, 2000
Question 15 - What advice can you give to others who are involved in the clinical side but interested in the technology aspects of this industry? How might they get involved without having to take computer classes to understand and participate? by HBInterview on August 17, 2000

Answer 15 - Clinicians are welcome to visit our sites. So far as we know, we have the most user-friendly expert systems for health care. Some of our programs are for consumers, and others for professionals. we extend an invitation to all interested parties to visit us. As a matter of fact we are actively seeking institutions, clinicians and health experts in various fields to collaborate in further development and to test existing products. by Martin Sturman on August 17, 2000
Question 16 - How do you see healthcare and expert systems in the future? What healthcare segments do you see embracing this technology? by HBInterview on August 17, 2000

Answer 16 - I predict a great future-some day for expert system applications in all aspects of health care, in both clinical and administrative areas, in improving
patient care and in allocation of financial, social, and other resources. When this will occur, I have no idea, because of the inertia and lack of imagination of the health care industry itself. by Martin Sturman on August 17, 2000
Question 17 - What additional information would you like to share that was not discussed this week? by HBInterview on August 17, 2000

Answer 17 - The questions have been so insightful, I have little more to offer. Further questions from members of HealthBond will be welcome and would be happy to continue any discussions on a one-to-one basis with anyone sufficiently interested in expert systems.

I would also like to thank HealthBond for the opportunity to host this forum; it's been a privilege. by Martin Sturman on August 17, 2000

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