Clinical experience with VIE-PNN, a knowledge-based system for planning the parenteral nutrition of newborn infants. Kirchner L, MD 1 , Popow C, MD 1,2 , Horn W, PhD 2,3 , Dobner M, MD 1 , Seyfang A, MS 2,4 , Miksch S, PhD 3,4 1 Department of Pediatrics, University of Vienna, Austria 2 Department of Medical Cybernetics and Artificial Intelligence, University of Vienna, Austria 3 Austrian Research Institute of Artificial Intelligence (OFAI) 4 Institute of Software Technology, University of Technology, Vienna, Austria Abstract Background: Knowledge-based systems are rarely used in the clinical routine. VIE-PNN, an interactive knowledge-based system, has been integrated in the local network of our patient data management system and used at the bedside since more than two years. Objective: To evaluate the performance and acceptance of a routinely used knowledge- based system. Methodology: Based on a few input data and the expert defined prescription rules, VIE- PNN calculates and displays suggestions for the components of parenteral nutrition solutions (PNS). These suggestions may interactively be changed by the prescribing physicians if considered necessary. For patients with partial enteral nutrition, the PNS components are reduced according to the ratio of parenteral/enteral fluid supply. We prospectively analyzed 50 PNS calculated in parallel by VIE-PNN and manually (MAN), i.e. by using a hand held calculator. We retrospectively analyzed 5539 PNS stored in the system’s database and evaluated a questionnaire asking physicians about their experience with VIE-PNN. Results: The mean time needed for calculating a PNS was 2.4 (VIE-PNN) vs. 7.1 minutes (MAN) corresponding to daily time savings of about 3/4 hour for 10 PNS calculations. Expert review detected errors or omissions in 22% (VIE-PNN) vs. 56% (MAN) of the PNS prescriptions. All errors in the VIE-PNN based PNS were related to interactively changed values. Analyzing the 5539 stored PNS, 4 of 16 parameters were interactively changed by the prescribing physician. The questionnaires showed a good overall acceptance of VIE-PNN. Time savings and improvement of precision were rated as equally important benefits. Conclusion: We conclude that the use of our knowledge-based system for PNS prescription led to important time savings and improvement of precision. Key Words: Knowledge-based system, clinical evaluation Correspondence to: Christian Popow, MD Univ. Klinik f. Kinder- u. Jugendheilkunde A-1090 Wien, Waehringer Guertel 18-20 Tel: +431 40400 3232, Fax +431 40400 3189 e-mail: popow@akh-wien.ac.at