Clinical Decision Support A Turnoff For Patients, Says Study

Patients trust doctors who make diagnoses without the aid of clinical decision support systems (CDSS) more than doctors who use these prompts and alerts in their EHRs, according to some studies. But a new study reveals that patients have an equivalent perception of physicians whether they make their diagnoses unaided or after seeking the advice of a colleague.

The inference drawn by researchers is that the use of computers, not the doctor's lack of knowledge, is what worries patients.

"What we found is that patients are uncomfortable about the use of technology, especially in this traditionally human relationship with physicians," said Victoria Schaffer, lead author of the study and a professor at the University of Missouri, in an interview with InformationWeek Healthcare. "It's not that they're concerned that their doctors don't know everything; they're fine with their doctors consulting with colleagues. But this new technology piece caused concern among some patients."

The researchers recruited 434 students from two Midwestern universities for their first experiment. The participants read one of three short vignettes that described an interaction between a physician and a patient who had had a recent ankle injury. In the vignettes, the doctor made an unaided diagnosis, used a computer-based diagnostic aid, or solicited the advice of an expert. After reading the passage assigned to them, participants completed questionnaires that asked them to evaluate the physician's behavior in several dimensions.

[ For more on clinical decision support systems, see Healthcare Providers Frustrated With Clinical Decision Support Tools. ]

While the group that read the vignette about using a computerized decision aid rated the doctor more negatively than either of the other groups did, their evaluations were also more polarized: some members gave the physician's behavior more negative or more positive evaluations than their cohorts did.

In an effort to understand the differences among individual perceptions, the researchers conducted two additional experiments. One sought to find out whether individuals' attitudes toward the use of statistics in patient care colored their perceptions. They did not.

In the other experiment, participants filled out another survey to measure their "locus of control," or the extent to which they believed they had control over events in their lives. It turned out that people who had a high locus of control tended to regard physicians who made unaided diagnoses more favorably than those who used decision aids.

Schaffer said it wasn't totally clear why this would be so. Her own view, she said, is that "[individuals with a high locus of control] believe that physicians who use their own unaided diagnosis are bringing more control to the situation, as opposed to relying on automation to help complete their thinking."

Physicians themselves have varying attitudes toward the use of computers in the exam room, she acknowledged. Some doctors feel that using an EHR in front of patients is distracting and impedes communication between them and their patients. Others say that patients appreciate the fact that they're using advanced technology that can help prevent medical errors and promote better care. From the patient standpoint, Schaffer said, the polarization of the decision aid group in her study supports both points of view.

In the study's conclusion, the authors urge clinicians and researchers to find ways to educate patients about the value of CDSS. Asked whether patients' negative attitudes toward the use of computers in healthcare would continue to be an obstacle, Schaffer noted that the current rapid spread of EHRs means "it's going to be the norm for generations to come. So the issue is not whether we're going to use decision support in our practices, but how we're going to discuss it with our patients. We need to move forward and find some way to make patients comfortable with the technology."

Federal Meaningful Use Stage 2 requirements will make your medical organization more competitive -- if they don't drive you off the deep end. Also in the new, all-digital Meaningful Mania Part 2 issue of InformationWeek Healthcare: As a nation, we're falling short of the goal of boosting efficiency and saving money with health IT. (Free with registration.)