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Decision support is an important area of medical informatics research. Computer-based decision-support tools facilitate diagnosis and the management of patients after a diagnosis has been established. Diagnostic decision-support tools, such as Meditel, Quick Medical Reference, DXplain, Iliad, and PEM-DXP are potentially useful 'expert systems.' Other management-support tools, such as systems that use clinical practice guidelines to create reminders and alerts, also have been developed and evaluated. We do the following: 1) provide an overview of diagnostic and management decision-support systems; (2) explore the background of and motivation behind these systems; (3) survey the uses of decision-support technology in office-based and inpatient pediatric practices; and (4) discuss the virtues and problems associated with some of these tools, and current controversies and future goals for computer-based decision support., Medical diagnostic decision-support (MDDS) systems can assist doctors in making diagnoses and treating patients. MDDS systems enable doctors to manage the overwhelming amount of medical information, increase diagnostic accuracy, and make medically and financially optimal treatment decisions. Primarily, MDDS systems offer possible diagnoses in response to the doctor's input of history, clinical findings, and test results. They can also present treatment options, remind doctors of the need for screening tests or prevention information, calculate drug dosages, and warn against potential adverse reactions or complications. Fears of interference with patient rapport, loss of physician autonomy, expanse of legal liability, and the belief that it is too difficult or not worthwhile to work with an MDDS system are not justified. Several MDDS and reminder systems are described and evaluated.

AbstractBackgroundComputer-based medical diagnostic decision support systems have been used for decades, initially as stand-alone applications. More recent versions have been tested for their effectiveness in enhancing the diagnostic ability of clinicians.ObjectiveTo determine if viewing a rank-ordered list of diagnostic possibilities from a medical diagnostic decision support system improves residents' differential diagnoses or management plans.MethodTwenty first-year internal medicine residents at Massachusetts General Hospital viewed 3 deidentified case descriptions of real patients. All residents completed a web-based questionnaire, entering the differential diagnosis and management plan before and after seeing the diagnostic decision support system's suggested list of diseases. In all 3 exercises, the actual case diagnosis was first on the system's list. Each resident served as his or her own control (pretest/posttest).ResultsFor all 3 cases, a substantial percentage of residents changed their primary considered diagnosis after reviewing the system's suggested diagnoses, and a number of residents who had not initially listed a “further action” (laboratory test, imaging study, or referral) added or changed their management options after using the system. Many residents (20 to 65 depending on the case) improved their differential diagnosis from before to after viewing the system's suggestions. The average time to complete all 3 cases was 15.4 minutes. Most residents thought that viewing the medical diagnostic decision support system's list of suggestions was helpful.ConclusionViewing a rank-ordered list of diagnostic possibilities from a diagnostic decision support tool had a significant beneficial effect on the quality of first-year medicine residents' differential diagnoses and management plans.