Epileptologist’s Assistant is a cost effective expert system used by nurses to produce preliminary progress notes for physicians in epilepsy follow up clinic.

The system was designed to cost effectively handle routine care in epilepsy follow up clinic. The strategy is to aid paramedical personnel to be better assistants to physicians. The system guides nurses in gathering patient histories and then generates preliminary progress notes along with a personalized patient information sheet. Around 300 questions could be asked of the patient; however, the system guides the nurse to ask 20 to 40 questions relevant to a particular patient. The progress note is reviewed by the physician with the patient. The physician could also review the clinical data, weigh the suggestions from the system, and modify the assessment or plan sections. The subjective and objective sections could also be modified but rarely needed to be. The system was in use at the Dallas VA Medical Center, Dallas, Texas, but it was decommissioned 1995 because it could not easily be integrated into existing hospital information system (HIS), and the eventual reorganization of the epilepsy clinic. A project is being developed to update and integrate the system into a generalized software framework for medical expert systems.

Availability: The system was designed to be integrated into the existing HIS.

Evaluation: Without the system a physician spent 21.35 min (+/- 0.95 sem, N=140) with the patient. With the system, the nurse spent 14.95 min (+/- 0.81 sem, N=27), and the physician spent 7.4 min (+/- 0.68 sem, N=27). Physician time was cut by about 66%. Using 1994 VA salaries for nurses and physicians, we have shown that the system reduced cost by about 40%. We have compared the quality of the progress note generated by physicians to the computer-generated note. Using a scoring system that divides the note data into essential and bonus categories, we found that the computer note quality was higher (95.5, +/-8.19 sd, N=12) compared to a physician's hand written note (85.2, +/-9.11 sd, N=24; p<0.01). Our informal assessment of the system is that it was well accepted by our physicians, nurses, and patients. Our physicians were willing to give up time on routine cases in exchange for more time on more difficult cases. Nurses liked the system because they could work at a higher level of expertise and spend more time with the patient. Patients seemed willing to accept the system even though they were waiting for two interviews (nurse and physician).