Kristine L Ming

‘Two-thirds of doctors’ actions may be superfluous’

Providing doctors with a series of computer recommendations generated from clinical guidelines can significantly improve their decision-making and treatment of patients, as well as save money.

Ben-Gurion University’s Medical Informatics Research Center recently published two articles on this discovery in the top journals in the field – the International Journal of Medical Informatics and the Journal of the American Medical Informatics Association. Prof. Yuval Shahar, Dr. Erez Shalom and Denis Klimov explained in the articles the “research milestones” of how medical informatics can impact doctors’ clinical workflow and medical research.

The first paper presents the first rigorous evaluation of the effect of computer-based decision support on doctors’ decisions when managing patients continuously over a significant period of time. The computer’s recommendations “dramatically enhanced their compliance with medical guidelines, increased the soundness of their actions, and prevented the performance of many redundant actions,” the researchers said.

They assessed decisions on managing preeclampsia (toxemia of pregnancy) taken by 36 obstetricians (24 residents and 12 board-certified experts).

Each clinician had to make 60 different decisions regarding six highly realistic scenarios of preeclampsia. The percentage of the doctors’ actions that were judged as correct and necessary increased from 27 percent when not using computerized guidelines to 91% when they were used. At the same time, the computerized assistance lowered redundant actions from 68% when not using the system to only 3% when using it.

The BGU system thus not only improves patient outcome but also saves money.

Recent data from Johns Hopkins University supports this surprising redundancy rate.

Thus, it is quite possible that two-thirds of doctors’ tests and other actions might well be unnecessary, possibly due to defensive medicine and/or ambiguity regarding the relevant evidence-based guideline that needs to be followed in each case, the researchers said.

But an intelligent decision- support system, which considers all of the patient’s data and the relevant clinical guideline, might significantly reduce that rate, they said.

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