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Proc AMIA Annu Fall Symp. 1997 : 263–267.
PMCID: PMC2233524

Changes in diagnostic decision-making after a computerized decision support consultation based on perceptions of need and helpfulness: a preliminary report.


We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or cases as the unit of analysis. It is possible that what may appear to be counter-intuitive, and perhaps irrational, may not necessarily be so. We are currently examining potential explanatory hypotheses in our ongoing current, larger study.

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Selected References

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  • Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. [PubMed]
  • Miller RA. Medical diagnostic decision support systems--past, present, and future: a threaded bibliography and brief commentary. J Am Med Inform Assoc. 1994 Jan-Feb;1(1):8–27. [PMC free article] [PubMed]
  • Berner ES, Webster GD, Shugerman AA, Jackson JR, Algina J, Baker AL, Ball EV, Cobbs CG, Dennis VW, Frenkel EP, et al. Performance of four computer-based diagnostic systems. N Engl J Med. 1994 Jun 23;330(25):1792–1796. [PubMed]
  • Kassirer JP. A report card on computer-assisted diagnosis--the grade: C. N Engl J Med. 1994 Jun 23;330(25):1824–1825. [PubMed]
  • Elstein AS, Friedman CP, Wolf FM, Murphy G, Miller J, Fine P, Heckerling P, Miller T, Sisson J, Barlas S, et al. Effects of a decision support system on the diagnostic accuracy of users: a preliminary report. J Am Med Inform Assoc. 1996 Nov-Dec;3(6):422–428. [PMC free article] [PubMed]

Articles from Proceedings of the AMIA Annual Fall Symposium are provided here courtesy of American Medical Informatics Association