XNEOr: development and evaluation of an expert system to improve the quality and cost of decision-making in neuro-oncology.

The treatment of brain tumors requires a large team of medical experts. However, the process of medical decision-making for these patients is hampered by the frequent inaccessibility of the experts because of conflicting scheduling, inconsistencies in the management of different patients, and the fact that multiple experts often yield multiple opinions. The goals of this work were (1) to develop and validate an expert system to assist the medical team deliver efficient, quality care to children with recurrent medulloblastoma, a common type of pediatric brain tumor, and (2) to determine if the expert system can be used as an educational tool. The results of our study indicate that residents enjoy learning by using XNEOr, the brain tumor expert system. XNEOr enabled residents to order appropriate ancillary tests for patients and to make fewer incorrect treatment decisions. The potential net effect of residents using XNEOr may be increased patient and family satisfaction and decreased probability of medical liability. At a time of important changes in our health care system, novel expert systems hold promise as tools to reduce medical costs, improve the quality of multi-expert medical care, and advance health care education.