• A S Elstein, C P Friedman, F M Wolf, G Murphy, J Miller, P Fine, P Heckerling, T Miller, J Sisson, S Barlas, K Biolsi, M Ng, X Mei, T Franz, and A Capitano.
• Department of Medical Education, University of Illinois at Chicago 60612, USA. aelstein@uic.edu
• J Am Med Inform Assoc. 1996 Nov 1; 3 (6): 422-8.

ObjectivesTo assess the effects of incomplete data upon the output of a computerized diagnostic decision support system (DSS), to assess the effects of using the system upon the diagnostic opinions of users, and to explore if these effects vary as a function of clinical experience.DesignExperimental pilot study. Four clusters of nine cases each were constructed and equated for case difficulty. Definitive findings were omitted from the case abstracts. Subjects were randomly assigned to one of four clusters and were trained on the DSS prior to use.SubjectsThe study involved 16 physicians at three levels of clinical experience (six general internists, four residents in internal medicine, and six fourth-year medical students), from three academic medical centers.ProcedureEach subject worked up nine cases, first without and then with ILIAD consultation. They were asked to offer up to six potential diagnoses and to list up to three steps that should be the next items in the diagnostic workup. Effects of DSS consultation were measured by changes in the position of the correct diagnosis in the lists of differential diagnoses, pre- and post-consultation.ResultsThe DSS lists of diagnostic possibilities contained the correct diagnosis in 38% of cases, about midway between the levels of accuracy of residents and attending general internists. In over 70% of cases, the DSS output had no effect on the position of the correct diagnosis in the subjects' lists. The system's diagnostic accuracy was unaffected by the clinical experience of the users.

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