Epileptologist's assistant: a cost effective expert system.

Epileptologist's Assistant is an expert system designed to cost effectively handle routine care in an epilepsy follow up clinic. The system guides nurses in gathering patient histories and then generates progress notes and a patient information sheet. The progress note, organized in the SOAP format, is reviewed by the physician with the patient. For difficult cases the physician may modify the Assessment or Plan sections; the Subjective and Objective sections rarely need modifications. The assertion of cost-effectiveness is based on time/motion data. Without the system a physician in our epilepsy clinic spends about 21 minutes seeing a patient. With the system the nurse spends about 14 minutes with the patient and the physician spends about 7 minutes. Two nurses and a physician handle the work load of 3 physicians. Physician time is cut by about 66%. Using the average salaries for physicians and nurses at the Department of Veterans Affairs, the cost of a clinic visit is reduced 39% by using the expert system and nurses. In addition, the progress note is more legible, it contains more information, Q/A procedures are implemented at the point of patient contact, and the data is entered into a computer system in a data field format.