Use of a computer to detect and respond to clinical events: its effect on clinician behavior
Journal
Ann Intern Med
Publication Date
1976 Feb
Volume
84
Issue
2
Pages
162-7
Summary:
- HIT Description: A computerized medical record with reminders developed locally by the Regenstrief Institute for Health Care More info...
- Purpose of Study: To determine the effects of a prospective, protocol-driven computer reminders for medication control on cliniciansÕ behavior
- Years of study: Not Available
- Study Design: Randomized parallel controls
- Outcomes: Impact of prescriptions and request for diagnostic studies
- Settings: The adult diabetes clinic of Wishard Memorial Hospital.
- Intervention: 226 patients who had a computer record were randomly assigned to a computer reminder group or control group.
- Evaluation Method: Randomized parallel controls
- Description: A computerized medical record developed locally by the Regenstrief Institute for Health Care. The system could generate prospective, protocol-driven recommendations to alert the clinician to the existence of , and the proper response to, simple events as reflected in the patient's computerized record.
- Strategy: All communications between the clinic and computer were through paper reports, which included the summary report of patient's information, the patient encounter form, and the surveillance report by which the computer transmitted its protocol-generated suggestions to the physician. The reports were placed in the front of the patient's chart before a visit.
- Extrinsic Factors in valuing cost and benefits: The clinic has a population of 600 patients, 3 diabetologists, 2 residents, 2 interns, 4 senior medical students, and 3 nurse clinicians. Rotation of residents, interns, and students interrupted continuity of care.
- Costs: The cost to maintain the patient's medical record and produce the above three reports was at $2.00 per patient-visit (not stated as to year of dollars, but approximately 6% of the average patient-cost per internist office visit) based on commercial computer-time charges, personnel tie, equipment, and supplies.
- Healthcare Utilization: The provider responded to 36% of study events when assisted by computer and 11% of event without computer by ordering the test in question (p
- Quality of Care and Patient Safety Outcome: The practitioners appropriately changed therapeutic regimens in 28% of study events when assisted by computer and 13% of control events (p
- Changes in efficiency and productivity: Not quantified, the author listed benefits including decreased cost of chart maintenance and improved physician's efficiency with respect to prescription-writing and chart review.