Reminders to physicians from an introspective computer medical record. A two-year randomized trial

Journal Name: 
Ann Intern Med
Authors: 
McDonald,C.J.
Hui,S.L.
Smith,D.M.
Tierney,W.M.
Cohen,S.J.
Weinberger,M.
McCabe,G.P.
Abstract: 
We developed a computer-stored medical record system containing a limited set of the total clinical data base--primarily diagnostic studies and treatments. This system responds to its own content according to physician-authored reminder rules. To determine the effect of the reminder messages generated by 1490 rules on physician behavior, we randomly assigned practitioners in a general medicine clinic to study or control groups. The computer found indications for six different actions per patient in 12 467 patients during a 2-year study: 61 study group residents who received computer reminders responded to 49% of these indications; 54 control group residents, to only 29% (p less than 0.0001). Preventive care (occult blood testing, mammographic screening, weight reduction diets, influenza and pneumococcal vaccines) was affected. The intentions of the study group to use a given action for an indication predicted their response to the indications (p less than 0.03, r2 = 0.33). The intentions of the control residents did not.
1
1984
Volume: 
100
Pages: 
130-8
Keywords: 
880, blood, clinical, Comparative Study, computer, Computers, Control Groups, diagnostic, Diet, Evaluation Studies, Family Practice, Indiana, Influenza, Intention, medical, Medical Records, Medicine, Occult Blood, patient, Patients, Physicians, Professional Practice, Quality of Health Care, Random Allocation, Record, resident, residents, ResNet, Respond, response, Support,U.S.Gov't,P.H.S., system