Using hindsight in medical decision making

As the clinical picture of a patient evolves over time, more information becomes available. Certain procedure require time to perform, causing delay between the time when the tests are ordered and when the results are available. Furthermore, as the patient's condition changes over time, serial measurements can be made. The availability of more data allows a more accurate assessment of the patient. Uncertainties, guesses or errors that were made early in the clinical course of patient care can also be identified and resolved when more information is available. Reasoning with a stream of data that changes over time presents a challenge to the designers of expert systems. The use of hindsight in expert system requires that appropriate attention be paid to the temporal relations of the data and that care is exercised in revising decision. I present a data-dependency system, the Temporal Control Structure (TCS), designed to support reasoning with data changing over time and show how it can be used to implement reasoning by hindsight.