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Aug 13 2013   9:43AM GMT

CDS vs. diagnostic tools: Which is better at eliminating diagnostic errors now?

Posted by: adelvecchio
CDS, clinical decision support, IBM Watson

Peter_Bonis_WKH UTDGuest post by Peter Bonis, M.D., vice president of product strategy of UpToDate, part of Wolters Kluwer Health

There are two issues related to diagnostic error upon which much of the medical community has achieved consensus: It is a pervasive and potentially deadly problem and health information technology holds great potential for reducing harm related to an incorrect diagnosis.

Indeed, several tools have already been developed and ongoing advances in computational science may ultimately produce approaches that surpass the best human cognitive skills. Advanced technology such as IBM’s Watson offer a provocative glimpse at how computers and human caregivers could one day interact to improve the quality and safety of care.

However, the question remains when technology will achieve such a vision. Current commercially available tools that can assist in generating a differential diagnosis have not yet proven to be highly effective in reducing the burden of diagnostic error in clinical practice. There are a number of limitations to existing technology and the way in which it can be incorporated into the workflow. In fact, many of these systems received a barely passing grade in a study published in December, 2011 by the Journal of General Internal Medicine.

Furthermore, helping clinicians achieve a comprehensive differential diagnosis (and ultimately a correct diagnosis) represents only a subset of the opportunity that health IT has to offer in reducing cognitive errors. Multiple studies have demonstrated that two out of every three clinical encounters generates a question that, if answered, would change five to eight care management decisions each day. Unfortunately, only 40% of questions are routinely answered, and sometimes not with the best, most current medical knowledge. Existing clinical decision support (CDS) tools not only assist clinicians in generating a differential diagnosis, but they also address the broader need for cognitive support in diagnosis and management-related decisions.

CDS allows clinicians to answer approximately 90% of their questions. Dozens of studies have demonstrated a link between CDS and clinically substantial changes in diagnosis, management and acquisition of medical knowledge. CDS has been directly linked to improved health outcomes, including shorter patient stays in hospitals and lower mortality rates. It has a proven impact on increased quality, safety and efficiency of care by providing actionable, detailed, evidence-based answers to clinical questions at the point of care.

Proper care cannot be achieved without a correct diagnosis. Better tools and changes to workflow will continue evolving to reduce potentially tragic outcomes associated with diagnostic errors. However, the dialogue surrounding what is still evolving — differential diagnosis software — should not overshadow what is already here: CDS at the point of care.

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