- mHealth apps for clinical decision support can help clinicians make better and quicker decisions about ordering diagnostic and lab tests, according to a recent study by researchers at the Baylor College of Medicine and the Centers of Disease Control and Prevention.
But those apps, researchers said, have to be evaluated and approved, so that doctors know which of the ever-growing number of mobile health apps are reliable. That’s particularly important when physicians report that they’re uncertain about what tests to order for one of every seven patients.
In their study, recently highlighted in the Journal of the American Medical Informatics Association, experts from Baylor and the CDC evaluated the effectiveness of one particular app, PTT Advisor, against typical decision support tools, including online and text resources. The app, developed by the CDC’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC), offers guidelines for diagnostic and test ordering decisions for certain coagulation and bleeding disorders.
“There are increasingly more physician-focused health apps available, and while physicians are becoming more comfortable using these apps, they don’t necessarily know which ones can help with diagnosis because they haven’t been evaluated,” Dr. Ashley Meyer, an assistant professor of medicine at Baylor and researcher in the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety (IQuESt) and the study’s lead researcher, said in a press release issued by Baylor. “Test ordering and diagnosis for certain hematologic disorders is particularly difficult for physicians. The team at the CDC’s Clinical Laboratory Integration into Healthcare Collaborative developed PTT Advisor to address these issues and approached our research group to conduct an evaluation.”
“For patients presenting with bleeding or thrombosis requiring expedited diagnostic work-up, consultations from hematologists may not be universally available to generalist physicians who often see such patients initially (there were fewer than 8,000 practicing hematologists and hematologists/oncologists in 2011 in the United States),” the study points out. “Health information technology has the potential to improve diagnosis by facilitating timely and easy access to information, such as identifying which tests to order. Therefore, reliable clinical decision support for generalists’ diagnostic investigations, including interpretation of laboratory test result abnormalities, should be widely available.”
To evaluate the mHealth app, Meyer and her team created eight vignettes based on challenging clinical cases, and enlisted 46 physicians from seven health systems. Each physician used the PTT Advisor app in four vignettes and other CDS tools in the other four vignettes.
After evaluating the results of the 368 vignettes, Meyer and her team found that physicians using the app were correct in test ordering and diagnostic decision-making almost 83 percent of the time, compared to about 70 percent accuracy when using traditional CDS tools. They also reported more confidence in making a decision, the researchers reported.
They also improved the speed in which they made a decision by about 51 seconds when using the app.
Meyer said the improvement in decision-making is important given that roughly 5 percent of American adults are misdiagnosed each year.
“Apps that add value to physician decision-making will be much easier to integrate with physician workflow and help impact clinical practice and reduce misdiagnosis,” added Dr. Hardeep Singh, a professor of medicine at Baylor and chief of the Health Policy, Quality and Informatics Program at the Houston VA’s IQuESt and senior author of the study.
The caveat added to this study is that the apps need to be evaluated first, and then identified as such to physicians who would use them. Without that research, the market will continue to house too many unproven or unsafe apps, and a majority of physicians will steer clear of all of them.
“Our results underscore several important policy implications to consider as healthcare apps are increasingly adopted,” the study concluded. “A multitude of mobile applications have been created to support physicians in their diagnostic decision-making, but few have been evaluated in terms of how they improve test ordering and diagnostic decision-making performance. While our methods were able to test clinical decision making and potential impact on patient care, most apps do not undergo similar testing. Physicians thus currently have no way of knowing which apps are useful and which are not trustworthy. All of these factors might limit app usefulness in the real world.”