Abstract
BackgroundClinical decision support systems (DSS) aimed at supporting diagnosis are not widely used. This is mainly due to usability issues and lack of integration into clinical work and the electronic health record (EHR). In this study we examined the usability and acceptability of a diagnostic DSS prototype integrated with the EHR and in comparison with the EHR alone.MethodsThirty-four General Practitioners (GPs) consulted with 6 standardised patients (SPs) using only their EHR system (baseline session); on another day, they consulted with 6 different but matched for difficulty SPs, using the EHR with the integrated DSS prototype (DSS session). GPs were interviewed twice (at the end of each session), and completed the Post-Study System Usability Questionnaire at the end of the DSS session. The SPs completed the Consultation Satisfaction Questionnaire after each consultation.ResultsThe majority of GPs (74%) found the DSS useful: it helped them consider more diagnoses and ask more targeted questions. They considered three user interface features to be the most useful: (1) integration with the EHR; (2) suggested diagnoses to consider at the start of the consultation and; (3) the checklist of symptoms and signs in relation to each suggested diagnosis. There were also criticisms: half of the GPs felt that the DSS changed their consultation style, by requiring them to code symptoms and signs while interacting with the patient. SPs sometimes commented that GPs were looking at their computer more than at them; this comment was made more often in the DSS session (15%) than in the baseline session (3%). Nevertheless, SP ratings on the satisfaction questionnaire did not differ between the two sessions.ConclusionsTo use the DSS effectively, GPs would need to adapt their consultation style, so that they code more information during rather than at the end of the consultation. This presents a potential barrier to adoption. Training GPs to use the system in a patient-centred way, as well as improvement of the DSS interface itself, could facilitate coding. To enhance patient acceptability, patients should be informed about the potential of the DSS to improve diagnostic accuracy.
Highlights
Clinical decision support systems (DSS) aimed at supporting diagnosis are not widely used
Thirty-four General Practitioner (GP) from Greater London using Vision electronic health record (EHR) system participated in the study (17 males)
GPs were asked if they had suggestions for improving the tool and the data collection process
Summary
Clinical decision support systems (DSS) aimed at supporting diagnosis are not widely used This is mainly due to usability issues and lack of integration into clinical work and the electronic health record (EHR). Usability issues including lack of integration into the clinical work is cited as a main barrier to broad adoption [9, 11,12,13]. This includes lack of integration with the EHR, which is important in order to trigger relevant patient information at appropriate points in the cognitive workflow and to prevent double entry of data, to both the DSS and EHR [14, 15]
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