Neurexam (Badanie Neurologiczne by Konrad Stawiski) - interactive neurological examination assistant and electronic health record.
Neurological examination is a key tool for the diagnosis of central nervous system disorders and therefore should be conducted very carefully and systematically. Electronic health record software (EHR) is promising and inevitable solution that supports reinforcing the quality of healthcare worldwide. Current EHRs usually do not offer any qualitative assistance in generation of reports, making this process time-consuming and prone to mistakes. In this concept, also retrospective analysis of data is limited. The aim of this study was to develop an interactive application for use in devices with Microsoft Windows OS, containing a digital interface for complex neurologic assessment of patient and a set of additional tools (including EHR).
The methods contained application development and deployment using Microsoft Visual Studio 2013 software, C# language based in .NET framework, components of Microsoft Internet Explorer, wkghtmltopdf project source files, and network services. An installer was developed using Internet-based ClickOnce technology. The authors reviewed the literature and interviewed clinicians to tackle the problems inherent in the neurological physical examination. Initial evaluation of software was conducted on 8 patients at Department of Neurosurgery and Neurooncology, Medical University of Lodz. The patients were fully neurologically examined without prior knowledge of medical history.
The application was created to maximize activities in relation to patient’s current body position. Usage of novel report generation approach – SISDS methodology – allows parameterization of electronic health records and therefore application in retrospective and prospective studies. Clinician can also make voice notes, collect results of additional tests, and because of autocomplete module – save time on typing. Application contains predefined basic diagnostic inference algorithms – generating automated description and interpretation of symptoms. Mean time of one full physical examination with parallel report generation was 29.2 minutes and this time trend to decrease in consecutive patients. The summaries contained good description of symptoms.
Development of interactive examination assistants and electronic health record software based on SISDS methodology has a potential to improve healthcare. Current outlook allows suggesting that parameterization of patients’ metadata allows data-mining tools to be applied; while systematically constructed medical documentation may impact in reducing the amount of malpractice incidents.
Project’s core concept was already awarded: (1) second award during session „Neurology & Neurosurgery” in the conference 9. International & 51. Polish Training & Scientific Medical Congress of Students' Scientific Societies and Junior Doctors “Juvenes Pro Medicina” 2013 in £ódŸ, (2) first award (for best project) in a nationwide competition of innovative projects i.e. „InnoTechAkademia - droga do w³asnych marzeñ” for the project entitled „Badanie neurologiczne jako interaktywny proces cyfrowy” (Eng. Neurological examination as an interactive digital process). Now we are continuing evaluation. As a top aim, we want to create medical diagnostic decision support system that will declare the help using machine learning tools, i.e., support vector machine with RBF kernel and kNN algorithm, based on experimentally achieved learning set (patient’s parameters) during the evaluation.
WARNING! This software is written only in polish language. If you want to
translate the software - please contact me!
WARNING! This project is stalled and I'm not longer working on it. If you want to reactivate the idea - please contact me.
This tool is containing:
1. patient handling system (EHR),
2. a digital formatted neurological examination,
3. basic diagnostic algorithms,
4. the ability to collect the results of tests,
5. reporting and presentation module.
The content of software was based on the following literature:
1. Fuller GN. How to perform a neurological examination. MEDICINE Volume 32:9
2. Fuller GN. Neurological examination made easy. 3rd ed. Edinburgh: Churchill Livingstone, 2004.
3. Lindsay KW, Bone I. Neurology and neurosurgery illustrated. 4th edition, Churchill Livingstone 2004.
4. Prusiñski A. Neurologia Praktyczna. 3rd edition. Wydawnictwo Lekarskie PZWL, Warszawa 2005.
5. Kozubski W, Liberski PP. Neurologia. Wydawnictwo Lekarskie PZWL, Warszawa 2008.
6. Turner C, Bahra A, Cikurel K. Crash Course Neurology. Elsevier Mosby, 2006.
7. Allan MA, Marsh J. History and examination. 2nd edition. Elsevier Limited, 2004.
8. Brazis PW, Masdeu JC, Biller J. Localization in Clinical Neurology. 5th Edition. Lippincott Williams & Wilkins, 2007.
9. Weiner WJ, Goetz CG, Shin RK, Lewis SL. Neurology for the Non-Neurologist. Lippincott Williams & Wilkins, 2010.
10. Gelb DJ. Where’s the logic in neurologic education? Experimental Neurology 184 (2003) S48–S52