Adoption and utilization of medical decision support systems in the diagnosis of febrile Diseases: A systematic literature review

Abstract

Medical decision support systems (MDSS) utilized for medical diagnosis aim to improve patient care; they do so by simulating the human cognitive process in order to arrive at a valid clinical conclusion. Medical decision support systems play a significant role in promoting an efficient and effective health care system. However, the adoption and usage of these systems in daily medical practice have been slow due to a lack of physician confidence in the systems and concerns about the erosion of professional autonomy, obscure physicians’ role, and diminished physician-patient relationships. Despite successes in the development of decision support systems, there is still a low adoption and utilization of MDSSs. This study reviews the development, adoption, and utilization of MDSSs in diagnosing Febrile Diseases between 2008 - 2020. We carried out a systematic literature review on the adoption and utilization of MDSS in diagnosing Febrile Diseases using guidelines provided in literature for systematic reviews and a PRISMA flow to guide paper selection, inclusion, and exclusion criteria. Three reviewers independently carried out literature searches on selected databases for MDSS to diagnose febrile diseases. After the initial searches, the reviewers cross-checked the results, and disagreements were resolved through mutual agreements. The reviewers extracted the data based on an agreed template, and a separate set of reviewers cross-checked this. The extracted data was then synthesized, analyzed, and split into various themes to answer the research questions. We identified 113 papers on MDSS development and utilization and 15 papers on studies relating to the adoption of MDSS. The analysis revealed that Fuzzy Logic was the most prevalent model of MDSS in use, while most models discussed in the papers were unimplemented. The results show that the main reason for proposing these models was to improve accuracy and precision. The main factors influencing the adoption of these models by medical facilities were usefulness, relative advantage, and ease of use. However, the reasons for adopting MDSS by the medical facilities were not expressed in 50% of the studies. In contrast, most of those who adopted MDSS disclosed that it was used to improve effectiveness and adherence to guidelines. Finally, compared to WHO statistics, it was determined that the number of papers did not correspond to the disease burden in the research continents. Although considerable research has been carried out on the adoption and utilization of MDSS, there is a paucity of research on implemented models of MDSS. Despite the advances in MDSSs and their accuracy in diagnosing diseases, many developed models have remained unimplemented in clinical practice. Future studies should focus on encouraging the actual usage of existing models that have not been implemented and conducting research on diseases with a high burden in their context. Governments and medical facility managers need to implement new policies, guidelines, and a support structure that will encourage the adoption and actual usage of MDSS in daily medical practice.