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 Researchers tested 23 online and mobile apps used by millions of
people who are trying to find out if their symptoms are serious and
what might make them feel better. The apps were imperfect at best,
offering the correct diagnosis on the first try only about a third
of the time.
For triage - assessing the urgency of the problem - the apps were
too cautious in situations requiring only self-care: only 33 percent
of the time, on average, were patients appropriately advised not to
go to the doctor.
At the other extreme, symptom checkers typically missed the severity
of the situation in one of every five cases requiring emergency
treatment.
Overall, the computer programs offered accurate triage advice for 57
percent of the standardized scenarios that were used in the
researchers’ tests.
“The risk is that people will be told to get care when they didn’t
need it and bear the costs and inconvenience, or they will be told
not to seek care when they have a life-threatening problem,” senior
author Dr. Ateev Mehrotra, a health policy researcher at Harvard
Medical School in Boston, said by email.
Because patients may not get much useful information from a long
list of possible diagnoses, the researchers rated the
symptom-checkers based on whether the programs spit out the right
answer first, or somewhere lower down on a list of up to 20 possible
alternative diagnoses.
The software listed the right diagnosis first in 24 percent of
emergencies on average, and for 40 percent of non-urgent cases.
Accuracy was better for common than for rare diagnoses.
The app that did best at giving the correct diagnosis on the first
try was DocResponse.com, at 50 percent.
Accuracy was better for the systems that used Schmitt or Thompson
nurse triage protocols, standard diagnostic tools used by clinicians
to provide advice over the phone. With these nurse triage protocols,
72 percent of patients got the appropriate guidance on the urgency
of their situation, compared with 55 percent without the protocols.
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One limitation of the study is that it used specific clinical
language to describe medical conditions in the test vignettes, which
may not provide an accurate reflection of how the symptom checkers
would perform for patients using nonclinical terms to describe their
conditions, the authors acknowledge in the British Medical Journal.
More research is needed to help build more accurate, safer and more
effective tools, and symptom checkers are unlikely to completely
replace the role of humans in diagnosis, particularly for patients
without Internet access, said Jeremy Wyatt, an e-health researcher
at the Leeds Institute of Health Sciences in the U.K., in an
editorial.
In some situations, symptom checkers are never a good idea, Wyatt
said by email. Patients who think they have something seriously
wrong – such as a very high fever, inability to stand, rapid
breathing, severe pain or bleeding – shouldn’t ask a computer
whether they need immediate help.
“Don’t waste your time surfing, call 911,” Wyatt said.
If it’s less urgent, patients may be able to spare the time to use
these online and mobile tools, Wyatt said. Patients should look for
reliable symptom checkers such as DocResponse.com or
FamilyDoctor.org, or one that uses the Schmitt or Thompson nurse
triage protocols, he added.
Non-urgent patients “can probably afford to spend a few minutes
checking symptoms online,” Wyatt said. “However, avoid just putting
your symptoms into Google; use a reliable online symptom checking
tool.”
SOURCE: http://bit.ly/1CrT3hm BMJ, online July 8, 2015.
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