Using Causal Knowledge to Create Simulated Patient Cases: The CPCS Project as an Extension of INTERNIST-1

The authors describe the development and implementation of a knowledge base in the domain of liver diseases in internal medicine which incorporated extensive knowledge of clinical pathophysiology. The knowledge base structure was an extension of the INTERNIST-1/QMR (Quick Medical Reference) knowledge base which is already in existence. However, it is estimated that it would take an order of magnitude greater effort to convert the existing INTERNIST-1/QMR knowledge base into this structure than has already been expended in the development of the existing INTERNIST-1/QMR knowledge base. With this expanded knowledge base, though, it was possible to generate simulated patient information which was then used in a system whereby the user was able to perform a “workup” on the patient. The authors propose that this ability to generate artificial data can be much like a “Turing Test” for judging the adequacy of any given knowledge base.