Decision support in psychiatry - a comparison between the diagnostic outcomes using a computerized decision support system versus manual diagnosis.
BACKGROUND
Correct diagnosis in psychiatry may be improved by novel diagnostic procedures. Computerized Decision Support Systems (CDSS) are suggested to be able to improve diagnostic procedures, but some studies indicate possible problems. Therefore, it could be important to investigate CDSS systems with regard to their feasibility to improve diagnostic procedures as well as to save time.


METHODS
This study was undertaken to compare the traditional 'paper and pencil' diagnostic method SCID1 with the computer-aided diagnostic system CB-SCID1 to ascertain processing time and accuracy of diagnoses suggested. 63 clinicians volunteered to participate in the study and to solve two paper-based cases using either a CDSS or manually.


RESULTS
No major difference between paper and pencil and computer-supported diagnosis was found. Where a difference was found it was in favour of paper and pencil. For example, a significantly shorter time was found for paper and pencil for the difficult case, as compared to computer support. A significantly higher number of correct diagnoses were found in the diffilt case for the diagnosis 'Depression' using the paper and pencil method. Although a majority of the clinicians found the computer method supportive and easy to use, it took a longer time and yielded fewer correct diagnoses than with paper and pencil.


CONCLUSIONS
This study could not detect any major difference in diagnostic outcome between traditional paper and pencil methods and computer support for psychiatric diagnosis. Where there were significant differences, traditional paper and pencil methods were better than the tested CDSS and thus we conclude that CDSS for diagnostic procedures may interfere with diagnosis accuracy. A limitation was that most clinicians had not previously used the CDSS system under study. The results of this study, however, confirm that CDSS development for diagnostic purposes in psychiatry has much to deal with before it can be used for routine clinical purposes.
Bergman
Lars G
LG
Dept, of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Berzelius way 3, S- 171 77 Stockholm, Sweden. Lars.Bergman@sll.se
Fors
Uno G H
UG
D002983:Clinical Competence; D020000:Decision Support Systems, Clinical / Q000592:standards*; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D003951:Diagnostic Errors; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005103:Expert Systems; D005240:Feasibility Studies; D006801:Humans; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis*; D010209:Paper; D011570:Psychiatry / Q000379:methods* / Q000592:standards; D013997:Time Factors; D014956:Writing