Differential Diagnosis Decision Support Systems in Primary and Out-of-Hours Care: A Qualitative Analysis of the Needs of Key Stakeholders in Scotland

Abstract

Background: Differential Diagnosis Decision Support Systems (DDDSS) and other forms of clinical decision support systems may have a role in supporting clinicians and the public in making decisions about differential diagnosis and accessing health care services. The aim of this qualitative, focus group study was to explore the needs of out-of-hours and primary care clinicians, and members of the public in relation to DDDSS. Methods: Twenty-nine participants (comprising 13 advanced nurse practitioners [ANPs], 7 general practitioners [GPs], 2 allied health professional advanced practitioners [AAPs], and 7 members of the public) took part in 1 of 6 focus groups. Data were audio-recorded, transcribed, and analyzed thematically. Results: Four themes were identified: (1) Current Practice, (2) Attitudes to DDDSS, (3) Implementation Considerations, and (4) Desirable Characteristics of DDDSS. Discussion: There may be a role for differential diagnosis decision support systems in supporting clinicians and members of the public; however, it is important that the needs of these groups are considered when designing or implementing any clinical decision support system in primary or out-of-hours care. More research is needed into how these systems could be used within clinical practice.

How do electronic risk assessment tools affect the communication and understanding of diagnostic uncertainty in the primary care consultation? A systematic review and thematic synthesis

“…When the patient walks through the door… quite clearly, quickly, we can see this is not a serious diagnosis. 48 …”

“…Included studies had publication dates ranging from 2003 to 2019 22–49. There was a broad range of targeted diagnoses, as well as data collection and analytical methods.…”

“…A second fear from clinicians regarding differential diagnosis generators, and clinical diagnosis eRATs, was of the tool interrupting how they normally think about diagnosis 47 48. The eRAT could distort how they handled diagnostic risk and unwanted risk suggestions made clinicians uncertain.…”

“…Finally, there were fears expressed regarding the medicolegal consequences of eRATs. Clinicians expressed concern that any eRAT output, if not acted on, could act as evidence against them26 48 and make them vulnerable to litigation. Here though, there was a negative case in the data, with one clinician reporting the eRAT was reassuring: that it acted as a ‘backstop’, reducing fear of missing a diagnosis.…”

Reaching 95%: decision support tools are the surest way to improve diagnosis now

“…Consulting a CDS-Dx product inserts an additional, somewhat disruptive step in clinical workflow. 21 Listening to the needs and wants of clinical users, 22 and considering the human factors issues involved, 23 can help optimise how often and how effectively these resources will be used. The next steps in the evolution of CDS-Dx, where these systems become well integrated in the electronic health record, will be especially important.…”