Decision Making by Emergency Room Physicians and Residents: Implications for the Design of Clinical Decision Support Systems

Clinical Decision Support Systems (CDSS) are typically constructed from expert knowledge and are often reliant on inputs that are difficult to obtain and on tacit knowledge that only experienced clinicians possess. Research described in this article uses empirical results from a clinical trial of a CDSS with a decision model based on expert knowledge to show that there are differences in how clinician groups of the same specialty, but different level of expertise, elicit necessary CDSS input variables and use said variables in their clinical decisions. This article reports that novice clinicians have difficulty eliciting CDSS input variables that require physical examination, yet they still use these incorrectly elicited variables in making their clinical decisions. Implications for the design of CDSS are discussed.