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Title Reminders to Physicians from an Introspective Computer Medical Record: A Two-Year Randomized Trial
Author(s) Clement J. McDonald, MD; Siu L. Hui, PhD; David M. Smith, MD; William M. Tierney, MD; Stuart J. Cohen, EdD; Morris Weinberger, PhD; and George P. McCabe, PhD
Source Annals of Internal Medicine, Vol. 100, Pages 130-138
Publication Date January 1984
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 < 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 < 0.03; r^2 = 0.33). The intentions of the control residents did not.

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