Decision support consists in helping a decision-maker to improve his/her decisions. However, clients requesting decision support are often themselves experts and are often taken by third parties and/or the general public to be responsible for the decisions they make. This predicament raises complex challenges for decision analysts, who have to avoid infringing upon the expertise and responsibility of the decision-maker. The case of diagnosis decision support in healthcare contexts is particularly illustrative. To support clinicians in their work and minimize the risk of medical error, various decision support systems have been developed, as part of information systems that are now ubiquitous in healthcare contexts. To develop, in collaboration with the hospitals of Lyon, a diagnostic decision support system for day-today customary consultations, we propose in this paper a critical analysis of current approaches to diagnostic decision support, which mainly consist in providing them with guidelines or even full-fledged diagnosis recommendations. We highlight that the use of such decision support systems by physicians raises responsibility issues, but also that it is at odds with the needs and constraints of customary consultations. We argue that the historical choice to favor guidelines or recommendations to physicians implies a very specific vision of what it means to support physicians, and we argue that the flaws of this vision partially ex-A.
In collaboration with the Civil Hospitals of Lyon, we aim to develop a "transparent" classification system for medical purposes. To do so, we need clear definitions and operational criteria to determine what is a "transparent" classification system in our context. However, the term "transparency" is often left undefined in the literature, and there is a lack of operational criteria allowing to check whether a given algorithm deserves to be called "transparent" or not. Therefore, in this paper, we propose a definition of "transparency" for classification systems in medical contexts. We also propose several operational criteria to evaluate whether a classification system can be considered "transparent". We apply these operational criteria to evaluate the "transparency" of several well-known classification systems.
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