The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients

Background 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). 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. Methods Thirty-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. Results The 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. Conclusions To 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

Scientific production related to silicosis throughout years as captured by PubMed in terms of scientific output (number of articles per year).

<p>Scientific production related to silicosis throughout years as captured by PubMed in terms of scientific output (number of articles per year).</p

Conceptual framework showing the complex links between scientific community, policy- and education-makers, traditional news coverage and novel data streams, and the public engagement.

<p>Adapted and modified from Ref. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166051#pone.0166051.ref019" target="_blank">19</a>].</p

Statistical tools and computational approaches used in the current manuscript.

<p>Statistical tools and computational approaches used in the current manuscript.</p

Statistical tools and computational approaches used in the current manuscript.

<p>Statistical tools and computational approaches used in the current manuscript.</p

Percentage of hasthags contained in tweets concerning silicosis.

<p>Percentage of hasthags contained in tweets concerning silicosis.</p

Dendrogram analysis of the relations between scientific production (as captured by Google Scholar and PubMed), news coverage (as captured by Google News), web queries (as captured by Google Trends), access to Wikipedia page and Internet activities (as captured by Twitter and YouTube).

<p>Dendrogram analysis of the relations between scientific production (as captured by Google Scholar and PubMed), news coverage (as captured by Google News), web queries (as captured by Google Trends), access to Wikipedia page and Internet activities (as captured by Twitter and YouTube).</p

Meta-regression analyses of studies concerning cortisol changes induced by soccer match-play, when including Coelho et al. [29].

<p>Meta-regression analyses of studies concerning cortisol changes induced by soccer match-play, when including Coelho et al. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0186100#pone.0186100.ref029" target="_blank">29</a>].</p

Average number of likes, retweets and hash-tags of tweets concerning silicosis.

<p>Average number of likes, retweets and hash-tags of tweets concerning silicosis.</p

Access to Wikipedia page related silicosis throughout years as captured by Wikitrends.

<p>Access to Wikipedia page related silicosis throughout years as captured by Wikitrends.</p