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.
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