The impact of Computer-assisted Test Interpretation on Physician Decision Making

Abstract

This research investigated the effect of computer-assisted test interpretation (CATI) on physicians' readings of electrocardiograms (ECGs). The authors used an experimental method based on direct observations of 22 cardiologists, each reading 80 ECGs, for a total of 1,760 (of which 1,745 were used in the study). There were 40 sets of clinically-matched pairs of ECGs, one with CATI and one without. Reading time was observed and interpretation accuracy was measured by criterion-referenced aggregate scoring. To control for potential biases, the findings were subjected to multivariate analyses using ordinary least-squares regressions. The impact of CATI on cardiologists' readings of ECGs is demonstrably beneficial: the main empirical conclusion of this study is that, compared with conventional interpretation, the use of computer-assisted interpretation of ECGs cuts physician time by an average of 28% and significantly improves the concordance of the physician's interpretation with the expert benchmark, without increasing the false-positive rate. Moreover, CATI is the most accurate and saves the most time when the ECGs have many unambiguous diagnoses. Given that computers alone cannot perform the task of cardiovascular diagnosis, and that cardiologists' ECG interpretations are greatly enhanced by ubiquitous CATI technology, it appears that the best approach is one that combines person and machine.

Common errors in computer electrocardiogram interpretation

“…In 14 cases, the computer did not recognize electronic pacemaker. It read the ECGs in a variety of ways, including banterior MI, intraventricular conduction delayQ [3], binferior MI, interventricular conduction delayQ [1], bWPW type BQ [1], bright bundle branch block (RBBB), lead reversalQ [1], bLVH, anteroseptal MIQ [1]Q, bintraventricular conduction blockQ [3], bLVHQ [1], bpulmonary disease pattern, ST elevation, consider anterior injury or ACUTE MIQ [1], banterior injury or acute MIQ [1], bpulmonary disease pattern, ST elevation, consider anterior injury or ACUTE MI, consider inferior injury or acute MIQ [1]. The rhythm was read as sinus in 11 cases and undetermined in 3.…”

“…It is currently used ubiquitously, saving innumerable hours for cardiologists. It was shown that the computer-assisted ECG reading cuts the physicianTs time by 28% and improves the quality of the diagnosis [3]. In cases when the computer was correct, the availability of computer interpretation improved the accuracy of the diagnosis.…”

“…This analysis by the computer is extremely helpful. It can considerably speed up the process of physician ECG interpretation and help prevent errors [3]. However, frequently inaccuracies are encountered which need manual correction.…”

Part 9: Acute Coronary Syndromes

“…128,129 Eight studies either found no effect or equivocal effect of the use of computerized ECG interpretation on diagnostic accuracy (LOE 1 111,(130)(131)(132) ). Two studies found evidence that the use of computerized ECG interpretation decreased diagnostic accuracy (LOE D1).…”

Computer analysis of implanted cardiac pacemaker rhythm

“…Automated ECG reports are clinically useful [8], and can speed up ECG interpretation and reduce errors [12]. Altering the programming of the Atria based on the results of this study, so that high-speed pacing detection is undertaken by Lead V4 rather than the historical Lead II may yield improved sensitivity and thus clinical usefulness of automated reports in the future.…”