Reduce Diagnostic Errors With Clinical Decision Support Systems

By Jade Thompson, RN, MSN, CPHRM

Diagnostic errors are among the most common and costly of all medical mistakes. A National Practitioner Data Bank study of malpractice claims spanning 25 years found that the occurrence of lethal and non-lethal errors associated with diagnostic error was roughly equal.

Clearly, diagnostic accuracy should be a major priority in healthcare, and some believe that use of a clinical decision support system (CDSS) can help. A CDSS is not a diagnostic application, but a tool that physicians can use to support their decision-making without losing control of their diagnosis or replacing hands-on care.

Role clarification – CDSS vs. doctor
The CDSS, and the medical providers who use it, perform separate, complementary tasks. To be clear, no computer can replace the judgement and bedside manner of an experienced physician.

Establishing a diagnosis is a multifactorial process that involves a whole-patient assessment supported by the interpretive judgement and personal interaction that physicians bring. Supercomputers are no replacement for that interaction. On the flip side, doctors are no replacement for supercomputers, either. The magnitude of data that computers store can't be contained by one human brain. 

Big data is here now, bringing both benefits and liabilities. On one hand, it's great to have access to an ocean of data. On the other, people can drown in the ocean. An excess of information can slow decisions down and sabotage their quality. When decision-makers are bombarded with so many details that they can't process and synthesize them intelligently and rapidly, diagnostic errors may occur. That's where a CDSS comes into play.

You get the map, I'll take the wheel
In 2007, the Journal of the American Medical Informatics Association defined CDSS as a tool that "provides clinicians, staff, patients, or other individuals with knowledge and person specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare.”

Let's put the emphasis on those words, "intelligently filtered." In our tech-first, data-driven era, we've accumulated more raw information than at any other point in human history – and our minds are not adapted to store and use big data. We need computers to store it for us, and if we're to use it at all, we need computers to extract it for us too – presenting a curated selection of relevant data to support the human work of decision-making.

A CDSS does not replace doctors’ decision-making. What it does, rather, is synthesize information quickly so that physicians can apply supercomputer-scale insights to human-scale contexts. The doctor is behind the wheel, navigating in real time. CDSS is the passenger who reads relevant information off a map so the driver can make the right split-second decisions when the moment comes.

Five tips to effective implementation and use of CDSS
  1. Get involved. Become an active player in the testing, rule-setting, and implementation for the CDSS, so you'll have a voice in making sure that data is up to date, usage is in sync with best practices, and any concerns you may have are addressed.
  2. Practice as a group. Teach your team to use the system constructively. Role-play diagnostic problem-solving using a CDSS, including scenarios in which you disagree with the recommended diagnosis. Develop a process in which the information provided is only one factor out of many, and ultimately, it's up to you to reach your own decision.
  3. Document decisions. Understand and acknowledge that deviations from CDSS may be appropriate in certain circumstances. Thorough documentation of medical decision-making promotes patient safety through conveying the rationale behind certain medical decisions.  Documentation also assists the physician and defense in the event of a lawsuit. 
  4. Emphasize bedside manner. If you navigate the system in front of a patient and you're still on the learning curve, don't express confusion or frustration. Equally, while the system may require some attention, don't forget that there's a patient in the room who needs you to remain emotionally present. Position the CDSS in a way that facilitates positive patient interaction.
  5. Monitor results. Apply the same quality standards to your CDSS as you do to your entire record-keeping system, and create systems to collect feedback from doctors and ensure quality control.
Doctors may not agree with a CDSS in every situation, and that's appropriate. However, by bringing together their separate human and technological proficiencies, they can work in concert to reduce diagnostic errors, raise quality of care, and improve patient outcomes.
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.

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