Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review.

Taku Harada,Kotaro Kunitomo,Taiju Miyagami,Taro Shimizu

doi:10.3390/ijerph18168435

Abstract

Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.

Highlights

Published: 10 August 2021Diagnosis by primary care physicians (PCPs) is an important task; there is always a risk of diagnostic error in the task of diagnosis
The results showed that there was no significant difference between the use of cancer decision support tools and the number of referrals, suggesting the possibility of the underuse of clinical decision support systems (CDSS) in primary care in the United
Farmer developed a knowledge-based CDSS to aid in the diagnosis of shoulder disorders in the primary care setting based on computer science literature and orthopedic opinion

Summary

Introduction

Published: 10 August 2021Diagnosis by primary care physicians (PCPs) is an important task; there is always a risk of diagnostic error in the task of diagnosis. Diagnostic errors are the greatest threat to patient safety in primary care [1]. 5% of adult patients in the United States experience diagnostic errors in outpatient settings every year [2]. Estimates from diagnostic error rates in selected research studies indicate that 12 million Americans suffer from diagnostic errors in primary care alone each year [2,3]. The same study found that 33% of these diagnostic errors led to “serious permanent injury”. This translates into at least 4 million people seriously harmed, including at least 1.7 million people who died, due to diagnostic errors [3]. The prevention of diagnostic errors in primary care is an urgent issue.

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