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Examining clinical decision support integrity: is clinician self-reported data entry accurate?
Anurag Gupta1, Ali S Raja, Ramin Khorasani
1Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Summary
Clinician data entry in imaging clinical decision support (CDS) is mostly accurate. However, some errors may intentionally bypass alerts, suggesting a need for improved electronic health record integration and quality improvement strategies.
Area of Science:
- Radiology and Medical Imaging
- Health Informatics
- Clinical Decision Support Systems
Background:
- Clinical Decision Support (CDS) systems in medical imaging aim to improve diagnostic accuracy and resource utilization.
- Accurate data entry by clinicians is crucial for the effective functioning of CDS tools.
Purpose of the Study:
- To evaluate the accuracy of clinician-entered data within an imaging CDS tool.
- To assess the impact of data entry errors on CDS alert functionality and potential overuse of imaging tests.
Main Methods:
- Retrospective analysis of 1296 patients undergoing CT angiography (CTA) for suspected pulmonary embolism (PE).
- Comparison of clinician-entered d-dimer values in the CDS with actual laboratory results.
- Categorization of data entry errors based on their impact on CDS alerts and clinical workflow.
Main Results:
- 90.7% of d-dimer values entered into the CDS were accurate.
- 4.2% of entries contained errors that successfully bypassed safety alerts, potentially leading to unnecessary CTAs.
- No pulmonary emboli were missed in the studied cohort.
Conclusions:
- The majority of clinician-entered data in imaging CDS is accurate.
- A subset of data errors may be intentional to avoid system alerts, highlighting a potential workflow issue.
- Quality improvement initiatives, including better electronic health record integration, are needed to optimize CDS adoption and effectiveness.
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