Reflection statement for participants in this CME activity:

This article is an example of applied computer technology and possibly an early foray into the application of artificial intelligence into the practice of medicine. By defining and computerizing an algorithmic process to recapitulate the recommended tasks to triage patients presenting for a chief complaint of chest pain, the triage of patients with chest pain can be performed accurately, reliably and more efficiently.

The authors of this manuscript used 2 expert physicians to review and assess the final triage decision making outcomes of the computerized triage process as well. The computerized version yielded more conservative triage decisions when compared to the computerized triage process. No improper triage decisions were noted for the computerized triage process. These findings support the safety of the computerized triage tool studied by the authors.

The authors noted some cost issues that they were interested in improving (i.e. trying to redirect low-risk patients to more appropriate or lower cost care venues for non-emergent care). This possibly is an indication that a business of medicine or financial reference frame was part of the underpinning motivation for this study. Government and insurance payers are trying to reduce costs of care. But there may be other significant frames of reference (i.e. reduced clinical errors, better data capture and archiving, better employee working conditions, faster patient throughput, fewer risks of unneeded services being provided, etc.) that may lead to significant value improvements from further computerization improvements. Computerization may allow more efficient and faster updates when new practice guidelines are promulgated. Sometimes deviation from algorithms is important when a patient has findings that makes addition, modification, or omission of a specific task in an algorithm appropriate. Computerized algorithms need to have a backup or downtime mechanism to execute the algorithms. Computerized algorithms may provide significant value if they can be adapted to better communicate with patients and caregivers who do not speak English as their primary language. Interfacing computerized algorithms with other computerized and non-computerized processes may require significant cost and/or effort.

(Physicians should be careful to avoid self-fulfilling prophecies or value judgments that result when triage algorithms are used to triage persons out of the emergency department.)