Accuracy of clinical data entry when using a computerized decision support system: a case study with OncoDoc2.

Some studies suggest that the implementation of health information technology (HIT) introduces unpredicted and unintended consequences including e-iatrogenesis. OncoDoc2 is a guideline-based clinical decision support system (CDSS) applied to the management of breast cancer. The system is used by answering closed-ended questions in order to document patient data while navigating through the knowledge base until the best patient-specific recommended treatments are obtained. OncoDoc2 has been used by three hospitals in real clinical settings and for genuine patients. We analysed 394 navigations, recorded on a 10-month period, which correspond to 6,025 data entries. The data entry error rate is 4.2%, spread over 52% of incorrect navigations (N-). However, the overall compliance rate of clinical decisions with guidelines significantly increased from 72.8% (without CDSS) to 87.3% (with CDSS). Although this increase is lowered because of N- navigations (compliance rates are respectively 95% and 80% for N+ and N- navigations), the benefits of HIT outweighted its disadvantages in our study.