SCIENCE
The way information is obtained determines its quality and uses.
Inherent human variability and biases affect the reliability and validity of assessment data that come from interactions between clinicians and patients.
Clinician biases may arise from training, previous or recent personal experience, and cultural factors. Patients also have biases that affect assessments. But in a thoughtful study comparing assessments by skilled and “calibrated” centralized clinician and other raters, 92% of variability was related to raters and only 8% to patients.(1)

Comparisons of clinician and computer assessments usually assume the clinician perspective is correct, adopting an anthropophilic view that overlooks the inevitable variability and biases of human interviewers. The procedural invariability of computer assessment overcomes these limitations of human interviewers. In but one example, a balanced-order methodologic study comparing clinician and computer assessment of suicide risk factors in the Columbia Suicide Severity Rating Scale (C-SSRS) found that two experienced clinicians administering the C-SSRS disagreed more with each other than either disagreed with the eC-SSRS.(2)
The FDA has recognized the primacy of patient perspective via patient-reported outcome (PRO) measures in registration trials of new drugs in disorders where subjective experience is salient, e.g., pain, pruritis, depression, anxiety and suicide risk.
“Use of a PRO instrument is advised when measuring a concept best known by the patient or best measured from the patient perspective.”(3)
There are many disorders where patient perspective is important. As eminent researcher and clinician, John Rush, said regarding depression treatments, “If the patient can’t tell she’s better, we’re kidding ourselves about treatment efficacy.”
Based on over 50 years of evaluation and use, electronic PRO assessments (ePRO) have excellent provenance and demonstrated value in clinical care and research. MERET’s cC-SSRS continues and extends this tradition, eliminating the effects of human rater variability to assure perfect administration reliability that improves instrument accuracy. ePRO assessments also increase patient candor with sensitive subjects, both individuals and topics such as suicidal ideation and behaviors.
In clinical care, computer-administered ePRO assessments are clinician extenders, improving outcomes that would not occur without ePRO.
We live by Sir William Osler’s dictum, “Begin with the patient, continue with the patient, and end with the patient.”
Citations
¹KOBAK KA, BROWN B, SHARP I, LEVY-MACK H, WELLS K, OCKUN F, WILLIAMS JB. SOURCES OF UNRELIABILITY IN DEPRESSION RATINGS. J CLIN PSYCHOPHARMACOL. 2009;29:82-5.
²MUNDT JC, GREIST JH, GELENBERG AJ, KATZELNICK DJ, JEFFERSON JW, MODELL JG. FEASIBILITY AND VALIDATION OF A COMPUTER-AUTOMATED COLUMBIA-SUICIDE SEVERITY RATING SCALE USING INTERACTIVE VOICE RESPONSE TECHNOLOGY. J PSYCHIATR RES. 2010;44:1224-8.
³FDA PRO GUIDANCE, DECEMBER 2009