Efficient use of medical IS: diagnosing chest pain

Purpose – The purpose of this paper is to evaluate the contribution of medical information systems (IS) to efficient use of information when diagnosing chest pain complaints with suspected acute myocardial infarction (AMI) as regards ordering of tests and accuracy of diagnosis.Design/methodology/approach – In total, 102 physicians were asked to diagnose three cases of chest pain in patients consulting an emergency department (ED) in a simulation study. Half of the participants had access to a medical IS with complete patient information and the other half of the physicians did not.Findings – It was found that participants who viewed the medical IS ordered fewer clinical examinations. Participants who viewed the medical histories made a more accurate main differential diagnosis (DD) of AMI. Physicians with access to the medical history reported significantly higher levels of confidence in their decisions, regardless of seniority.Originality/value – The findings suggest that IS leads to better utilization o...

[1]  Wojtek Michalowski,et al.  Prospective evaluation of the MET-AP system providing triage plans for acute pediatric abdominal pain , 2008, Int. J. Medical Informatics.

[2]  Johanna I. Westbrook,et al.  Do online information retrieval systems help experienced clinicians answer clinical questions? , 2005, Journal of the American Medical Informatics Association : JAMIA.

[3]  D. Baker,et al.  Health literacy and the risk of hospital admission , 1998, Journal of General Internal Medicine.

[4]  Tariq M. Khan,et al.  Theory of deferred action: Agent-based simulation model for designing complex adaptive systems , 2010, J. Enterp. Inf. Manag..

[5]  Jason Young,et al.  The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care , 2011, Int. J. Medical Informatics.

[6]  D. Spiegelhalter,et al.  Evaluating medical expert systems: what to test and how? , 1990, Medical informatics = Medecine et informatique.

[7]  Kai Zheng,et al.  Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective , 2010, J. Am. Medical Informatics Assoc..

[8]  James M. Walker,et al.  Electronic medical records and health care transformation. , 2005, Health affairs.

[9]  Stuart M. Speedie,et al.  Impact of Prior Clinical Information in an EHR on Care Outcomes of Emergency Patients , 2009, AMIA.

[10]  John T Nagurney,et al.  Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. , 2005, JAMA.

[11]  C Kooperberg,et al.  Using logistic regression to estimate the adjusted attributable risk of low birthweight in an unmatched case-control study. , 1991, Epidemiology.

[12]  L. Goldman,et al.  Triage of Patients with Acute Chest Pain and Possible Cardiac Ischemia: The Elusive Search for Diagnostic Perfection , 2003, Annals of Internal Medicine.

[13]  M. Drummond,et al.  A rational framework for decision making by the National Institute For Clinical Excellence (NICE) , 2002, The Lancet.

[14]  Anirban Basu,et al.  Value of Information on Preference Heterogeneity and Individualized Care , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[15]  Brian O'Neil,et al.  The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. , 2007, Annals of emergency medicine.

[16]  Joseph S. Valacich,et al.  The effects of task complexity and time availability limitations on human performance in database query tasks , 2005, Int. J. Hum. Comput. Stud..

[17]  André Kushniruk,et al.  How Usability of a Web-Based Clinical Decision Support System Has the Potential to Contribute to Adverse Medical Events , 2008, AMIA.

[18]  Robert Woolard,et al.  Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department , 2000 .

[19]  Steven R. Simon,et al.  Physician attitudes toward health information exchange: results of a statewide survey. , 2010, Journal of the American Medical Informatics Association : JAMIA.

[20]  Viswanath Venkatesh,et al.  Explaining physicians' use of EMR systems and performance in the shakedown phase , 2011, J. Am. Medical Informatics Assoc..

[21]  Wendy L. Currie,et al.  The policy-practice nexus of electronic health records adoption in the UK NHS: An institutional analysis , 2011, J. Enterp. Inf. Manag..

[22]  D. Redelmeier,et al.  Medical decision making in situations that offer multiple alternatives. , 1995, JAMA.

[23]  Joshua R. Vest,et al.  What should we measure? Conceptualizing usage in health information exchange , 2010, J. Am. Medical Informatics Assoc..

[24]  Arild Faxvaag,et al.  Research Paper: Effects of Scanning and Eliminating Paper-based Medical Records on Hospital Physicians' Clinical Work Practice , 2003, J. Am. Medical Informatics Assoc..

[25]  Robert A. Greenes,et al.  Commentary: Informatics in biomedicine and health care. , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[26]  Joshua R. Vest,et al.  Health Information Exchange and Healthcare Utilization , 2009, Journal of Medical Systems.

[27]  L. Goldman,et al.  Evaluation of the Patient with Acute Chest Pain , 2000 .

[28]  Eric C. Pan,et al.  The value of health care information exchange and interoperability. , 2005, Health affairs.

[29]  Kevin B. Johnson,et al.  The MidSouth eHealth Alliance: Use and Impact in the First Year , 2008, AMIA.

[30]  D. Mcniel,et al.  The Relationship Between Confidence and Accuracy in Clinical Assessment of Psychiatric Patients' Potential for Violence , 1998, Law and human behavior.

[31]  Robert S. Rudin,et al.  Why clinicians use or don't use health information exchange , 2011, J. Am. Medical Informatics Assoc..

[32]  Wojtek Michalowski,et al.  Decision Making by Emergency Room Physicians and Residents: Implications for the Design of Clinical Decision Support Systems , 2009, Int. J. Heal. Inf. Syst. Informatics.

[33]  Marta Kersten,et al.  Designing man-machine interactions for mobile clinical systems: MET triage support using Palm handhelds , 2007, Eur. J. Oper. Res..

[34]  Dominik Aronsky,et al.  Emergency physicians' behaviors and workload in the presence of an electronic whiteboard , 2005, Int. J. Medical Informatics.

[35]  W John Boscardin,et al.  Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. , 2005, JAMA.

[36]  E. Ford.  Does Exercise Reduce Inflammation? Physical Activity and C-Reactive Protein Among U.S. Adults , 2002, Epidemiology.

[37]  W. Hersh,et al.  Factors associated with successful answering of clinical questions using an information retrieval system. , 2002, Bulletin of the Medical Library Association.

[38]  L. Chambless,et al.  Arterial stiffness and the development of hypertension. The ARIC study. , 1999, Hypertension.

[39]  J. Sterne,et al.  A review identifies and classifies reasons for ordering diagnostic tests. , 2007, Journal of clinical epidemiology.

[40]  Kim M. Unertl,et al.  Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use , 2011, J. Am. Medical Informatics Assoc..

[41]  Keng Siau,et al.  The effect of data model, system and task characteristics on user query performance: an empirical study , 1997, DATB.