How
“Isabel” Clinical Diagnosis Decision Support System
Alters Physician Utilization of Lab Tests
After
Dark Daily mentioned the Isabel clinical decision support system
in Doctors
Get Electronic Help with Their Diagnoses Via Decision Support
Software, we got a lot of interest from our readers in how
this and other types of clinical decision support systems might
effect laboratories by altering how physicians order lab tests.
Dark Daily contacted Isabel
Healthcare to see if they could point us towards any case
studies on the subject. Indeed, between July and August 2006 Isabel
Healthcare Inc. and Kaiser
Permanente worked together on an evaluation of the Isabel
system within the Kaiser health system.
After using the Isabel diagnosis decision support system, 65%
of responding Kaiser doctors said that Isabel helped them consider
important diagnoses that had originally not been considered. In
15% of cases, using the Isabel system influenced doctors to order
additional lab tests, but not in any cases did the use of Isabel
result in the cancelling of an order for a lab test.
More than half, 51% of doctors, felt that Isabel somewhat or significantly
increased the quality of care that their patients had received,
and 45% agreed that it required little additional time to use
of the Isabel system to develop their diagnosis and management
plan for their patients. 93% of doctors found Isabel helpful in
answering their questions and more than half thought Isabel was
extremely user friendly. “Premature closure and failure
to consider all likely diagnoses is the single most common cause
of diagnosis error,” said Isabel Healthcare CEO and Co-Founder
Joseph Britto, MD. “For a given set of clinical features,
point of care diagnosis decision support systems have been shown
to decrease premature closure by reminding clinicians of likely
diagnoses. These systems are likely to have a positive impact
on the laboratory community as physicians eliminate some additional
diagnoses through the use of appropriate lab tests.”
Naturally, the study from Isabel Healthcare can be expected to
cast Isabel in a favorable light, but two multi-center, collaborative
studies also point out important benefits of Isabel to practitioners.
One published paper, “Diagnostic
omission errors in acute paediatric practice: impact of a reminder
system on decision-making” concludes that junior doctors
that use a Web-based diagnostic system during acute pediatric
assessments significantly improve the quality of their diagnostic
workup with use of decision support software and also reduce diagnostic
omission errors. The benefits were achieved without any adverse
effects on patient management following a quick consultation.
Another paper, “Assessment
of the potential impact of a reminder system on the reduction
of diagnostic errors: a quasi-experimental study” concludes
that decision support systems, through the use of patient- and
context-specific reminders, have the potential to reduce diagnostic
omissions across all subject grades for a range of cases.
This positive feedback for Isabel reinforces the belief of Dark
Daily that clinical decision support systems like Isabel will
be implemented and used at an increasing pace in all types of
health care facilities. In many cases, such systems will guide
doctors to the same diagnostic conclusions that they would have
drawn without the systems, but the payoff will come from the small,
but significant, number of cases, where the clinical decision
support system guided the physician to consider different diagnoses.
At this early stage in the adoption and use of clinical decision
support systems, the evidence indicates no major shifts in how
physicians order and use laboratory tests. At the same time, experience
in the use of these systems points to the fact that physicians
become better at ordering the right laboratory test at the right
time, then using the test results to ensure a better healthcare
outcome for their patients. Dark Daily predicts that the wider
use of clinical decision support systems will create a demand
for closer consultation and collaboration between referring clinicians
and pathologists and other laboratory professionals.
Related Articles:
Diagnostic
omission errors in acute paediatric practice: impact of a reminder
system on decision-making
Assessment
of the potential impact of a reminder system on the reduction
of diagnostic errors: a quasi-experimental study
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