Electronic Health Records

Study: Patients lack confidence in clinical decision support

According to a study recently published in Medical Decision Making, physicians who used computerized clinical decision support (CDS) to confirm a diagnosis or treatment plan were viewed as incompetent or less capable by patients.  While CDS is widely seen as a helpful tool and has been shown to improve physician performance, the University of Missouri study asserts that patients are mistrustful of the technology, perceiving physicians as “less professional, less thorough, and having less diagnostic ability.”

Participants in the study were asked to rate their reactions to a physician when presented with a series of vignettes describing an exam for an illness or injury.  Researchers found that the hypothetical patients were less likely to trust a diagnosis provided by a computer, and less likely to be pleased with a positive outcome when a physician used CDS.  But they were also less likely to blame a physician for a negative event when the clinician relied on the computer as opposed to the clinician making a poor decision by himself.

However, when a physician ignored the computer’s recommendation and made his own decision, patients were more likely to be harsh with their criticism after something went awry.   “The physician was deemed to be least deserving of punishment when he or she used the decision aid and heeded its advice but most deserving of punishment if he or she used the decision aid and defied its advice,” the study explained.  The researchers did not fully explore whether or not patients felt the same way when their physician consulted with a human specialist.

Victoria Shaffer, Ph.D., the lead author on the study, could not pinpoint why patients were so averse to CDS, even though the capability is included in most EHR systems and is endorsed by CMS as a core objective of Meaningful Use.  “Patients may be concerned that the decision aids reduce their face-to-face time with physicians,” Shaffer said. “[Those] who desire to control their health outcomes are much less comfortable with health care practitioners’ use of technology.  Anything physicians or nurses can do to humanize the process may make patients more comfortable.”

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