In august 2004, the Avicenna project was started at Pezeshkyar Pars Biomedical Co. in an attempt to provide a comprehensive medical decision-support system assisting health professionals with clinical diagnosis in the normal course of their duties. The main goal of Avicenna project was to design and implement of Avicenna software program so that when a user enters patient symptoms and signs, a ranked list of possible disorders and recommended further tests will be presented. In addition, Avicenna should be able to offer help in other areas like supporting clinical coding and documentation, managing clinical complexity and details, monitoring medication orders and avoiding duplicate or unnecessary tests, and so on. Funds for this work have been provided by a grant from the Semnan Science & Technology Park, the Iranian Ministry of Science, Research and Technology, and by a grant from the TAKFA, the Iranian Ministry of Information and Communication Technology. The main features of Avicenna consists of:

1. Purposes of the Avicenna: As mentioned before, Avicenna is designed to assist general practitioners in their task of medical diagnosis. In addition to this main goal, Avicenna is able to offer help in non-clinical areas like administration and cost control as well as in patient care and disease management. In general, we can cite four key functions for Avicenna: (a) Administrative like supporting clinical coding and documentation, authorization of procedures, and referrals; (b) Managing clinical complexity and details including tracking orders, review medical information, referrals follow-up, and preventive care; (c) Cost control by monitoring medication orders and avoiding duplicate or unnecessary tests; and (d) Medical diagnosis support. So Avicenna can be applied to many different purposes of clinical tasks.
2. Why It Is Needed: Problems in modern medicine are often very complex and evidence for the best choice to be made is often lacking. Decisions which made by physicians are arbitrary and highly variable (within one physician and between physicians) and lacking explanation or ‘rationalization’. On the other hand, the body of potentially useful knowledge that is relevant to even a relatively narrow diagnostic area may be too large to make the optimal (diagnostic) decision on the spot. Meanwhile, modern communication technology further increases the amount of available knowledge, potentially even further complicating this situation, so medical practitioners never have been faced with such an explosion in the amount of medical knowledge. Moreover, individual patients need ‘individualized’ decisions, because their characteristics differ from the ‘average’ and because of their individual wishes. Apparently, individualizing the general results of research may be cumbersome and time consuming, while modern medical practice demands for efficiency, cost-effectiveness and high technical quality. In addition to what has been said, in most countries insufficiency of medical specialists has increased the mortality of patients suffered from various diseases. Not only the insufficiency of medical specialists will never be overcome within a short period of time, but also current practice for medical treatment directs patients to consult specialist for further diagnosis and treatment, taking normally a few days, weeks or even months the waiting time for treatments. By the time the patients see the specialist, the diseases may have already spread out. As most of the high risk diseases could only be cured at the early stage, the patients may have to suffer for the rest of their life. It is readily understandable that the above comprises an enormous task and challenge for modern medicine in general and individual doctors in particular, illustrating the need for medical decision-support systems such as Avicenna. These systems deal with medical data and knowledge domain in diagnosing patients’ conditions as well as recommending suitable treatments for the particular patients. In addition, the systems serve to improve the quality of medical decision making, increase patient compliance and minimize iatrogenic disease and medical errors. Also, employing medical decision-support systems could remarkably reduce the cost, time, human expertise and prescribing errors.
3. Who Will Use It: Although Avicenna is originally designed and developed for general practitioners, but it may be appreciated by both generalists and super-specialists alike. General practitioners can use Avicenna to review diseases and help decide which test or medication to (or not to) order. Avicenna helps them catch up and keep up with any terms he or she may not be familiar with or has forgotten, and helps them with terms and synonyms, too. In addition, many general practitioners can use Avicenna as a quick reference of a disease that they have previously studied but not commonly seen. On the other side, specialists and super-specialists may use Avicenna to review conditions outside of their specialty. Specialists also can use Avicenna to review drugs, treatments, and rare conditions. However it’s not all and Avicenna may be used by others. For example, nurses can use Avicenna to quickly review any new diseases or syndromes they encounter. Similarly, caregivers in rural areas are other potential users that Avicenna helps them with differential diagnosis of common or rare symptoms and abnormal findings, and also, with encountering emergency conditions in primary care. Finally, students can also use Avicenna to learn and review new diseases, symptoms and treatments.
4. The Benefits of Avicenna: Many potential benefits can be remarked for Avicenna. For example, it can help physicians in making true medical decisions. Avicenna is designed to consider patient symptoms and signs and create a ranked list of possible disorders and recommend further tests. Also, it can reduce in medication errors and adverse drug events by providing reminders and prompts. Avicenna has the potential to not only reduce medications errors but also to change medication prescribing patterns. Many physicians don’t have a very clear idea of how to prescribe a drug for their patients or what information they need to provide and Avicenna can provide step by step guidance to the process of rational prescribing as same as providing source of new ideas and perhaps an incentive for change. Avicenna can also increase compliance with recommended clinical guidelines and reduce rates of inappropriate diagnostic tests. As a result, Avicenna will make development of evidence-based medicine. Another potential benefit of the implementation of Avicenna is that it will increase the efficiency of administrative tasks and thereby allow clinicians to spend more time in direct patient care and reasonably, it will cause to save more time. Avicenna also offers health care practitioner a means to rapidly access medical information at the point of care. In addition to what has been said, the enhancement of patient education and empowerment by prescribing in more details and ordering to go on appropriate diet is from potential benefits of Avicenna. It can also cause to reduce of costs due to fewer medication errors and adverse drug events, increased efficiency in the execution of patient care —particularly in relation to appropriate use of interventions, referrals, tests and drugs—, increased use of generic drug brands, pay-for-performance initiatives, and reducing length of inpatient stay. Finally, by saving electronically patients’ information, Avicenna would be able to extract required data from database just in a few seconds, analyze it statistically and present in desired technical formats. Such reports are beneficial tools for physicians and caregivers to manage their healthcare centers.
5. Knowledge Sources: The references which are utilized by Avicenna for its knowledge base is broad and includes most standard general internal medicine and speciality textbooks, journals, and many review articles, including Harrison’s Principles of Internal Medicine, Cecil-Loeb’s Textbook of Medicine, The Merck Manual of Diagnosis and Therapy, WHO  documents, and also Guidelines from various websites such as National Institutes of Health Website and so on. At present, there are more than 2,000 conditions or diseases in the Avicenna knowledge base as well as over 1,000 findings and about 120,000 relationships. It also covers complications, toxicity, side effects aside from disorders, and many other related topics and images. In addition, Avicenna has minimal information on drugs and medications (about 1000 drugs), and it includes a list of drug interactions.
6. Potential Problems: While it is expected that the use of the Avicenna would improve the safety, quality and efficiency of health care, its success will depend on multiple factors and a variety of reasons may be responsible for its lack of success. For example, in the era of evidence-based medicine, the advice of ‘a software program’, functioning as a black box is unacceptable: an advice must be accounted on the basis of research published in the peer reviewed literature. The majority of conventional protocols and consensus guidelines also often fail to refer explicitly to the literature. Therefore, (diagnostic) advices suggested by a computerized tool should come with the appropriate references from the literature. Also, physicians can play a vital role in the success of Avicenna as well as they can create many barriers due to desire for autonomy, physician personality and emotional issues, lack of trust of administration, failure of systems to clearly demonstrate better quality and outcomes, failure of organizations to provide effective incentives to use systems, lack of physicians leadership and involvement with project management, and finally, cultural differences to healthcare management. In addition, introduction of Avicenna should be done as careful and thorough as is done for drugs that are new on the market. After introduction, Avicenna software will need constant monitoring of users’ needs and maintenance to keep up with the latest results of medical research.