Misdiagnosis by doctors leads to many of the cases that we hear about in the news (or on the TV show “House.”). We live in an age where doctors are under pressure to see as many patients in as little time as possible. Not surprising, then, that many physicians often diagnose the most obvious medical condition they deem appropriate without full and detailed consideration of what alternative medical conditions may also be present.
Kaiser Permanente and the Veterans Health Administration are bringing the issue of misdiagnosis to the forefront with their adoption of a Web-based “decision support” software program called “Isabel.” Isabel and similar systems help doctors by offering an array of possible diagnoses they might not have considered or prompting them to perform appropriate tests on patients with certain symptoms. In a study at the VA Medical Center in Northport, NY, Isabel suggested the correct diagnosis in 98% of cases in which the system was used. Doctors have recognized that this system is an excellent training tool for residents and an invaluable reminder that the simplest explanation is not always the right one when it comes to medical conditions.
I spoke to a friend of mine who is a general practice doctor at the Scott & White Clinic in Georgetown, TX. The facility was on the verge of adopting a decision support program that involved PDAs programmed to suggest an appropriate diagnosis based on symptoms in each general practice exam room. “At what point,” she asked, “am I even necessary anymore? I’m starting to question why I even needed to go to medical school – Anyone could use this thing and come up with the right diagnosis!” Unfortunately, my friend’s attitude will likely be mirrored by many doctors who are set in their ways and unfamiliar with this technology. It’s true that, in a large portion of medical cases, the right answer is a simple one, but decision support programs assist doctors who use them correctly to consider alternative conditions, which may save a patient’s life.
Dark Daily predicts that use of clinical decision support systems like Isabel will increase in coming years. It is a logical consequence of the patient safety movement as well as the motivations provided by pay-for-performance programs. Another reason why health care facilities are likely to embrace these systems is that they can electronically document that the physician did the right thing for the patient, based on the fact that the clinical decision support system agreed with the physicians’ evaluation of symptoms and likely medical conditions.
What remains to be seen is how such clinical decision support systems impact laboratory test ordering patterns and how clinicians follow up on laboratory test results. Clinical laboratory managers and pathologists in health systems and hospitals already using such systems report that overall test utilization declines in the weeks following implementation. Going forward, they say that physicians begin to increase their consultations with pathologists and technical lab staff. So the early evidence is that clinical decision support systems can encourage physicians to make better use of the clinical laboratory’s expertise.