RSS Feeds
A Computer-Assisted Medical Diagnostic Consultation Service
Implementation and Prospective Evaluation of a Prototype
- Richard A. Bankowitz, MD;
- Melissa A. McNeil, MD;
- Sue M. Challinor, MD;
- Ronnie C. Parker, MD;
- Wishwa N. Kapoor, MD, MPH; and
- Randolph A. Miller, MD
Abstract
Study Objective: To evaluate the accuracy of a computeraided consultation service using academic general internists and the Quick Medical Reference (QMR) diagnostic program; and to study the impact of the consultation on the diagnostic behavior of physicians caring for patients.
Design: Prospective study of the diagnostic accuracy of computer-aided consultation in 31 cases, as well as a prospective study of ward team diagnoses and opinions before and after consultation.
Setting: General medicine wards of two tertiary care centers.
Participants: Thirty-one patients identified as posing a diagnostic challenge and meeting eligibility criteria, as well as the housestaff caring for these patients.
Measurements and Main Results: After 6 months follow-up, diagnoses were established in 20 of 31 cases. The diagnostic sensitivity of the computer-assisted diagnoses, 85% (95% CI, 56% to 97%), was similar to that of the consult service physicians, 80% (95% CI, 55% to 94%), but better than that of the ward teams, 60% (95% CI, 33% to 81%; P = 0.03 using the binomial test). The consultation influenced the postconsultation differential diagnoses of the ward teams in 26 of the 31 cases (95% CI, 62% to 95%). House officers rated the consultation service as being educationally helpful in 25 of the 31 cases (95% CI, 62% to 94%).
Conclusions: Computer-aided diagnostic consultation, when provided by physicians familiar with the limitations of the system and capable of overriding inappropriate suggestions, was both accurate and educationally helpful in most cases. The system provided reasonable diagnostic suggestions not previously considered by the ward teams and these suggestions were valued sufficiently to cause alteration of the original differential diagnoses.
Article and Author Information
-
From the University of Pittsburgh School of Medicine and the Veterans Administration Medical Center, Pittsburgh, Pennsylvania. For current author addresses, see end of text.
-
Grant Support: The QMR project was supported by grants from the CAMDAT Foundation of Farmington, Connecticut, and from the Department of Medicine of the University of Pittsburgh School of Medicine. Drs. Bankowitz and Parker were funded in part by National Library of Medicine Training Grant 1 Tl5 LM07059-01. Dr. Kapoor is funded in part by Research Career Development Award NIH K04 HLO1899-01 A1 and is Principal Investigator of grant NIH 1 RO1 HL36735-01A1 both of The National Heart, Lung, and Blood Institute. Dr. Miller is the recipient of Research Career Development Award 5 K04 LM00084 of the National Library of Medicine.
-
Requests for Reprints: Richard A. Bankowitz, MD, University of Pittsburgh, Section of Medical Informatics, B50A Lothrop Hall, 190 Lothrop Street, Pittsburgh, PA 15261.
-
Current Author Addresses: Drs. Bankowitz, Parker, and Miller: University of Pittsburgh, Section of Medical Informatics, Pittsburgh, PA 15261.
Dr. Kapoor: University of Pittsburgh, Division of General Internal Medicine, Pittsburgh, PA 15261.
Drs. McNeil and Challinor: Veterans Administration Medical Center, Primary Care Medicine, Pittsburgh, PA 15240.
- ©1989 American College of Physicians
