Dermatology-specific diagnostic decision support technology does not significantly change how often hospital-based physicians call in specialists, suggesting that doctors still want the expertise of dermatologists even when they have tools available to help with differential diagnoses, a new study shows.
In the 12 months before and 18 months following adoption of the VisualDx diagnostic decision support system at the Hospital of the University of Pennsylvania in Philadelphia, the average number of inpatient consultations with dermatologists stayed at 1.0 per month, according to the study, published early online in the journal Diagnosis.
“This is important because these tools by design suggest numerous potential diagnoses, which could result in an increase in unnecessary testing and specialty consultation, and associated costs and harms, particularly in the hands of less experienced clinicians,” corresponding author Dr. Craig Umscheid, director of the Penn Medicine Center for Evidence-based Practice, said in a release from the Penn’s Perelman School of Medicine.
“Conversely, if there were a significant reduction in dermatologic consultations, it would have suggested that general internists, emergency room physicians, family doctors and pediatricians, all of whom by definition are not specialists in dermatology, may have relied on the tool to make dermatologic diagnoses, rather than consulting a dermatologist for help,” Umscheid continued.
The researchers wrote that differential diagnosis generators “offer particular promise for reducing diagnostic errors” in dermatology. “Research suggests dermatologic conditions are often misdiagnosed, which can be exacerbated when access to dermatologists is limited,” the journal article said. Misdiagnosis, the authors noted, has been blamed for 40,000-80,000 deaths in U.S. hospitals per year.
“The technology can help users overcome cognitive shortcomings such as availability bias, in which providers diagnose patients with conditions they’ve recently seen or can easily recall, rather than those conditions that are most likely to occur. It can also reduce fund of knowledge deficiencies by directing users to diagnoses they might not have otherwise considered,” explained lead author Dr. John Barbieri, who graduated from Perelman in 2014.
Physicians across the Penn Medicine system — not just at the flagship hospital — used VisualDx for differential diagnoses a median 474 times a month starting in September 2012, according to the study.
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“Technology like this has great promise, but it can’t help patients unless it’s actually used,” Umscheid said. “Previous studies have been primarily simulations, where researchers take variables from case studies and input them into the software to retroactively assess the diagnostic accuracy of the software. However, our purpose was to determine if a differential diagnosis generator like VisualDx would actually be used by providers if implemented in a hospital, and we found that it is — most often on mobile devices and by inpatient providers.”
