No Respect For Clinical Decision Support
By Ken Congdon, Editor In Chief, ken.congdon@jamesonpublishing.com
Follow Me On Twitter @KenOnHIT
I read a study last week that, quite simply, boggled my mind. This study appeared in the January issue of Medical Decision Making and it basically showed that patients have less respect for physicians that consult EHR clinical decision support tools before making a diagnosis. Researchers surveyed 543 college students (a demographic that grew up on technology) and provided them with three episode-of-care scenarios in which they visited a physician. Everything about the care they received was identical except how the doctor reached the diagnosis — unaided, with an EHR’s help, or by consulting another physician. Doctors who sought computer assistance were graded nearly 10% lower than physicians who made a diagnosis without electronic aid.
I’m sure there is some psychological or sociological reason for these results, but they just don’t make good sense to me logically. Think about it. Would you prefer to fly in a 747 with a pilot who doesn’t use the plane’s computerized navigation tools? Would you prefer a homicide detective to work a case without the aid of today’s sophisticated forensics and DNA technology? I’m quite certain most folks would say “no.” In these instances, the technology is seen as enhancing the capabilities of the pilot or detective, increasing their chances of success. Why, then, is a doctor’s use of technology perceived as a weakness?
Perhaps it’s the elevated status physicians have held in our society over the years. Doctors are expected to be brilliant minds. Many are. Maybe the use of clinical decision support tools shatters our image of this (to quote Seinfeld) “delicate genius.” Perhaps it’s a bit like finding out your favorite athlete’s God-given talents have been aided by performance enhancing substances. That’s just not fair. Many may prefer to be treated by a brilliant diagnostician like television’s Dr. Gregory House rather than say, IBM’s Watson, but imagine how much more effective House could have been if he had the data and computing power of Watson to support or refute his instincts. It probably would have made for a much shorter (albeit less interesting) television program because most of his cases would have been solved with the first diagnosis rather than the fourth, fifth, or sixth.
That’s really the key takeaway here. I think many patients have a misconception about what clinical decision support actually is. I feel many believe it does a doctor’s job for them — that the physician just types in a few symptoms and the computer blindly spits out the most likely diagnosis. However, like other technologies before it, clinical decision support is simply designed to enhance the expert capabilities of the physician. It’s intended to ensure doctors consider all avenues, don’t overlook any data (as all humans are sometimes likely to do), and ultimately validate their treatment plans.
Perhaps the best way to combat the negative perception of clinical decision support is through better patient education. In fact, Kaiser Permanente is one provider that is committed to increasing patient acceptance of EHRs during office visits. Kaiser advises its physicians to encourage patients to follow along with them in the EHR. These doctors clearly explain the benefits of the computerized tools they are using to record and assess their patients’ conditions. More efforts like this will be necessary to help patients truly understand how the new technology benefits them. Remember, clinicians aren’t the only ones experiencing a cultural shift with the introduction of IT in healthcare — patients are as well.