TY - JOUR
T1 - Diagnostic Reasoning and Decision Making in the Context of Health Information Technology
AU - Patel, Vimla L.
AU - Kaufman, David R.
AU - Kannampallil, Thomas G.
N1 - Funding Information:
The writing of this manuscript was supported by funds from the James S. McDonnell Foundation (Grant No. 220020152 to Vimla L. Patel).
PY - 2013/10
Y1 - 2013/10
N2 - Diagnostic reasoning and medical decision making have been focal areas of research in the fields of medical education, cognition, and artificial intelligence in medicine. Drawing on several decades worth of research, we propose an integrated summary of prior research on diagnostic reasoning and decision making-in terms of both historical development and theoretical shifts. We also characterize the changes in research and theory resulting from the incorporation and adoption of health information technology in the clinical work place. In this paper, we differentiate between the various forms of diagnostic reasoning and trace the evolution of the various models of reasoning, including knowledge-based, exemplar-based, and visual strategies. We also discuss the effect of clinical expertise on reasoning processes. Within the medical decision-making research, we delineate the various approaches highlighting decision-making errors that arise due to the nature of heuristics and biases and other factors. Although there has been significant progress in our understanding, there is still a need for greater theoretical integration of disparate empirical phenomena. Specifically, there is a need to reconcile the various characterizations of reasoning and to evaluate the similarity and differences in the context of current health care practice. Finally, we discuss the role of human factors research in the study of clinical environments and also in relation to devising approaches and methodologies for understanding, evaluating, and supporting the diagnostic reasoning and decision processes.
AB - Diagnostic reasoning and medical decision making have been focal areas of research in the fields of medical education, cognition, and artificial intelligence in medicine. Drawing on several decades worth of research, we propose an integrated summary of prior research on diagnostic reasoning and decision making-in terms of both historical development and theoretical shifts. We also characterize the changes in research and theory resulting from the incorporation and adoption of health information technology in the clinical work place. In this paper, we differentiate between the various forms of diagnostic reasoning and trace the evolution of the various models of reasoning, including knowledge-based, exemplar-based, and visual strategies. We also discuss the effect of clinical expertise on reasoning processes. Within the medical decision-making research, we delineate the various approaches highlighting decision-making errors that arise due to the nature of heuristics and biases and other factors. Although there has been significant progress in our understanding, there is still a need for greater theoretical integration of disparate empirical phenomena. Specifically, there is a need to reconcile the various characterizations of reasoning and to evaluate the similarity and differences in the context of current health care practice. Finally, we discuss the role of human factors research in the study of clinical environments and also in relation to devising approaches and methodologies for understanding, evaluating, and supporting the diagnostic reasoning and decision processes.
KW - diagnostic reasoning
KW - expertise
KW - heuristic and biases
KW - knowledge-based solution strategies
KW - medical decision making
KW - naturalistic decision making
KW - technology-mediated cognition
UR - http://www.scopus.com/inward/record.url?scp=84884640462&partnerID=8YFLogxK
U2 - 10.1177/1557234X13492978
DO - 10.1177/1557234X13492978
M3 - Article
AN - SCOPUS:84884640462
SN - 1557-234X
VL - 8
SP - 149
EP - 190
JO - Reviews of Human Factors and Ergonomics
JF - Reviews of Human Factors and Ergonomics
IS - 1
ER -