Patients Question Clinical Decision Support Use

Using clinical decision support technology (CDS) is such a standard and helpful health IT approach – not to mention a central Meaningful Use feature — that we almost take its existence for granted. Apparently, however, patients aren’t as tolerant of computer-assisted decision making as clinicians and IT experts are, according to a new study published in Medical Decision Making.

The study suggests that patients actually distrust physicians who use CDS, labeling them as “less professional, less thorough, and having less diagnostic ability,” according to a report by EHR Intelligence.

The study, done by University of Missouri researchers, showed participants vignettes depicting an exam for an illness or injury. These participants were then asked to rate their reactions to the physicians showed in the vignettes.

The results suggest strongly that potential patients are unnerved by the notion of physicians making use of CDS.  Researchers found that the study subjects were less likely to trust computer-driven diagnoses, and moreover, less likely to be happy with a positive outcome if that outcome involved CDS use.

Perhaps the only social benefit to physicians using CDS was that subjects were less likely to blame a doctor for a negative outcome if the doctor relied on CDS to make a decision.  If a doctor used CDS, ignored its conclusions then had a negative outcome, patients felt strongly that he or she was deserving of punishment.

It’s not exactly good news for healthcare providers that patients are likely to be squeamish about their using CDS. That being said, my guess is that doctors can do a lot to make patients comfortable simply by explaining what they’re doing and making patients feel confident about the process. In the end, after all, patients care most about their relationship with the provider, computer-aided or not.

About the author

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

2 Comments

  • If a doctor comes across as a med school dropout who needs the computer to tell him how to do his job, patients won’t be very accepting. If it comes up on screen based on test and exam results and the doctor says that the system ‘suggests’ that he do some tests, etc. as a result, I think the response would be more favorable. CDS is not meant to replace a doctor’s judgement but rather to help one explore the possibilities including illnesses not often seen but still possible, as well as to help a doctor narrow down a diagnosis where on the surface there are too many possibilities.

  • CDS can be presented as a checklist, making sure certain survellance issues are attended – for a dibetic it can be “looks like it’s been more than a year since you’ve had your diabetic eye exam – let’s make thar referral now.” Airplane pilots use checklists as part of their routine, and using checklists does not diminish the perception of competice of the pilot (in fact, someone who does not use the checklists is a riskier pilot). This apporach works with CDS in medicine too. It’s not something like “I don’t know what to do – let’s go ask the computer”. Instead it’s “let’s make sure we haven’t overlooked some routine things that you are due for.”

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