1. Medical Hypothesis Testing July 27, 2006 Bill Bushey Emily Jenkins

2. Motivation We would like to provide a way to aggregate the collective knowledge that has been gained by the performance and known outcomes of thousands of procedures so that doctors can tap into this collective knowledge to quickly obtain information on the experiences of their peers.

3. Goals Our goal is to provide doctors with a broader view of the success of treatment options, beyond their own experiences and the experience of their colleagues.

4. Goals Ability to access multiple databases to search for records Output shows the effectiveness of procedures on a continuum Only relevant procedures will appear in the output Initially have a choice of searching for any of ~10 specified diagnosis, with the potential to easily expand that option

5. What We Started With Nothing!  No access to any databases that may or may not exist ICD-9-CM coding system exists NHDS 2004 data

6. Prepping the Data Appended random outcomes to the records Load records into 1 database Delete records without a procedure attached to them (~1/3), leaving over 200,000 records Drop excess diagnoses and procedures Load records into an additional 4 databases Add test diagnosis and procedure to 1 database Create ‘specialty hospitals’ to increase the number of minority patients

7. Stanford Medical Center University Texas Houston Medical Hospital University Virginia Health System Upstate Medical Center Harvard Medical Center Our Databases

8. How It Works Connects to specified databases Builds a query using the user specified criteria Searches for and returns records that fall under the search criteria The most commonly used procedures are displayed, along with their percent occurrence, mean outcome, and mean standard deviation of outcome

9. Demonstration

10. Testing Use added test diagnosis and procedure to verify the mean and standard deviation logic, as well as the search Command line program

11. Problems Initial  What would the real database(s) look like?  What data is needed  Issue of the interdependence of procedures (likely more than one procedure performed per diagnosis, or multiple diagnoses) During  Failure of machine containing the database  Hypothesis testing using fuzzy logic  No java graph package  Auto-complete difficulties

12. Recommendations to the Medical Community Medical community should have a standard format for electronic records Primary diagnosis and primary procedure performed for that diagnosis should be specified Standards for evaluating patient outcome Changes in ICD-9-CM codes Program Usable ICD-9-CM file

13. Relics What we’ll leave behind  3 page UML diagrams  5 page User Manual  1 cd of database data  Change log  6 pages of testing documentation  17 pages of API documentation

14. Future Work Able to handle multiple diagnosis Multiple procedures for the same diagnosis Ability to print table or graph Secure access to databases as well as login information Better error handling Tabbed results with support for multiple searches