Why haven’t computerized interpretations gotten any better?

Almost all pulmonary function test systems seem to come with a module that can perform a computerized interpretation of PFT results. Their accuracy has been studied occasionally, often by the developers of a particular algorithm and just as often a rosy picture is painted. Given their limited (and likely pre-cleaned) data sets I am sure this is accurate as far as it goes. I have done my own admittedly very unscientific comparison and would say that for two-thirds of the patients tested the results are probably okay. The other third? Varying degrees of not so much.

This concerns me because the very locations that could use the expert assistance of computerized interpretation, small clinics and doctor’s offices where inexperienced and under-trained staff are usually tasked to perform the tests and where this would be most useful, cannot rely on it. This fact was highlighted in a recent report in the European Respiratory Journal which showed that computerized interpretation did not improve the quality of care in general practitioners offices.

Computerized interpretation of pulmonary function tests have been around for at least 40 years. At one time or another developers have used expert systems, branching logic, fuzzy logic and neural networks. Algorithms have been tweaked and updated as our understanding of pulmonary function testing has improved but none are essentially any better or more accurate now than in the 1970’s.

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