title: Accuracy of a computerized clinical decision-support system for asthma assessment and management.
abstract: OBJECTIVE
  To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic.
  
  
  METHODS
  Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009.
  
  
  METHODS
  CDSS and physician assessments of asthma severity, control, and treatment step.
  
  
  RESULTS
  Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167 (39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all 'cough' to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits.
  
  
  CONCLUSIONS
  The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations.
  
  
  CONCLUSIONS
  A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients.
authors.affiliation: National Center for Patient Safety, Ann Arbor, Michigan, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Hoeksema
authors.forename: Alia
authors.initials: A
authors.lastname: Bazzy-Asaad
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Lomotan
authors.forename: Diana E
authors.initials: DE
authors.lastname: Edmonds
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ramírez-Garnica
authors.forename: Richard N
authors.initials: RN
authors.lastname: Shiffman
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
mesh_terms: D000555:Ambulatory Care Information Systems; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D003237:Connecticut; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States; D014584:User-Computer Interface