Clinical decision support systems can promote diagnostic accuracy, patient satisfaction

A new study published in PLOS ONE shows that CDS systems can assist providers in making skin-related diagnoses without affecting consultation time.
By Kat Jercich
09:05 AM

Clinical decision support systems have been found to help providers make safer and better choices at the point of care. Now, a new study shows that they can also improve patient satisfaction.

The study, published this past week in PLOS ONE and funded by the LEO Innovation Lab, found that using a visual clinical decision support system – in this case, VisualDx – led to an increase in diagnostic accuracy and to patients feeling more involved in medical decisions.

"For this reason, a visual clinical decision support system with a wide range of clinical images of common and rare dermatological diagnosis can be helpful," said the research team in the study.

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"These historic times are really typified by anxiety," said Dr. Art Papier, VisualDx's CEO, in an interview with Healthcare IT News. "We're all anxious about COVID. … Anything you can do to reduce patient anxiety is important.

"Patients like when doctors look things up and use imagery to teach them during the visit. Lots of patients are anxious that when they have something on their skin that's harmful or dangerous. … It's not good enough to hunt and peck your way through Google" for an image, Papier continued.

WHY IT MATTERS

For the study, general practitioners conducted appointments with 31 patients who had been diagnosed by a dermatologist with skin conditions. 

Of the 21 different diagnoses, the clinicians who were using the CDS system had higher rates of correctly diagnosing conditions including basal cell carcinoma, alopecia, hereditary Kaposi's sarcoma, poliosis, psoriasis, rosacea and stasis dermatitis. Those using standard consultations showed better rates for diagnosing morphea, dermal nevus and pruritus.

Overall, the diagnostic accuracy improved 34% for doctors using the CDS system compared with those using standard consultations.

The clinical decision support system also increased aspects of patient satisfaction, although it was negatively correlated with the length of the consultation.

Significantly more patients who had consultations using the CDS system agreed "with the statement that 'the doctor involved me in decisions as much as I wanted' compared with a standard consultation," wrote the researchers.

When it comes to diagnostic accuracy and clinical decision support, Papier told Healthcare IT News that it has always been a priority to VisualDx developers to include a variety of skin tones in test sets, given the potential for missed diagnoses in patients with darker skin.

"Our mission has always been about diagnostic accuracy and equity, and making sure you have diagnostic accuracy in people of color," said Papier.

"You have to have good data for good AI. Your models won't be good if you're just training on light-skinned images," he continued. "Obviously, if you don't have these tools trained for skin of color and you have a patient with a dark skin tone and it doesn't work, it's just straight-out bias."

Papier also argued that CDS can help avoid "availability bias," especially at a time when COVID-19 is at the top of everyone's minds. 

Noting that VisualDx can be used via telehealth, he said, "COVID is in our dreams. ... Decision support technology can help us think about other things" that could be affecting patients.

THE LARGER TREND

When it comes to optimizing clinical decision support technology, experts say it's important to understand what the organizations and physicians are trying to accomplish, among other best practices.

"For example, physicians may want clinical decision support tools that provide ready access to a specific patient with a specific problem so they can efficiently and effectively evaluate a patient’s current status and prescribe the most appropriate therapy," said David Lareau, CEO of Medicomp Systems, in an interview with Healthcare IT News' Bill Siwicki in 2019.

Reports also forecast CDS finding substantial adoption in the areas of patient surveillance and population health. 

“With the delivery of healthcare becoming more complex, there is an urgent need for a superior user interface, both to reduce the load on the physician, as well as ensure that the physician is informed of the latest treatment options and protocols,” said Mike Jude, research manager, digital health, at Frost & Sullivan, this past year.

ON THE RECORD

"These are turbulent times, obviously. … We have to give the clinicians resources –  particularly the generalists who have to cover all complaints. Decision support really meets the needs of those generalists, particularly the ones starting out who are very tech-savvy," Papier said.

 

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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