Methods Inf Med 1995; 34(01/02): 79-84
DOI: 10.1055/s-0038-1634587
Original article
Schattauer GmbH

Searching for Answers on a Clinical Information System

C. Safran
1   Center for Clinical Computing, Beth Israel Hospital, Harvard Medical School, Boston MA, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
09 February 2018 (online)

Abstract:

We examined observational data on the use of a clinical computing system in an effort to develop an empirical model of clinicians’ information needs. Clinicians turn to information systems most often to review the results of diagnostic studies. After that clinicians turn to information systems most often for communication. Bibliographic retrieval is the third most frequent reason for use, but is an order of magnitude less frequent than either results inquiry or electronic mail. Secondary retrieval of aggregate data from a clinical database is two orders of magnitude less common than primary retrieval. In a study at our hospital, clinicians gained access to an information resource during 16% of all general medical visits of patients with human immunodeficiency virus (HIV) infection while the patient was present. Insofar as our narrow focus on the primary care of HIV infection models the larger context of clinical medicine, clinicians are most often looking at information relating to therapeutics. Whatever knowledge structures are adopted, they must accommodate this observed need for therapeutic information.

 
  • References

  • 1 Warner HR, Olmsted CM, Rutherford BD. HELP – a program for medical decisionmaking. Comput Biomed Res 1972; 5: 65-74.
  • 2 Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Syst 1983; 7: 87-102.
  • 3 Scherrer JR, Baud R, Brisebarre E, Messmer E, Assimacopoulos A. A hospital information system in continuous operation and expansion: concepts, tools and migration. In: Proceedings of the 10th Symposium on Computer Applications in Medical Care. Washington DC: 1986: 120-32.
  • 4 Scherrer JR, Baud RH, Hochstrasser D, Ratib R. DIOGENE: An integrated hospital information system. MD computing 1990; 7: 81-9.
  • 5 Degoulet P, Menard J, Berger C, Plouin PF, Devries C, Hirell JC. Hypertension management: the computer as a participant. Am J Med 1980; 68: 560-7.
  • 6 Degoulet P, Chatellier G, Devries C, Lavril M, Menard J. Computer-assisted techniques for evaluation and treatment of hypertensive patients. Am J Hypertension 1990; 3: 156-63.
  • 7 Billault B, Degoulet P, Devries C, Plouin PF, Chatellier G, Menard J. Use of a standardized personal medical record by hypertensive patients: a randomized prospective trial. MD Comput 1995; 1: 31-5.
  • 8 McDonald CJ, Blevins L, Tierney WM, Martin DK. The Regenstrief Medical Records. MD Comput 1989; 5: 34-47.
  • 9 McDonald CJ, Murray R, Jeris D. et al. A computer-based record and clinical monitoring system for ambulatory care. Am J Public Health 1977; 67: 240-5.
  • 10 McDonald CJ. Protocol-based computer reminders, the quality of care and the nonperfectibility of man. N Engl J Med 1976; 295: 1351-5.
  • 11 McDonald CJ, Tierney WM. Computerstored medical records. Their future role in medical practice. JAMA 1988; 259: 3433-40.
  • 12 Bleich HL, Beckley RF, Horowitz G, Jackson J, Moody E, Franklin C, Goodman SR, McKay MW, Pope RA, Walden T, Bloom SA, Slack WV. Clinical computing in a teaching hospital. N Engl J Med 1985; 312: 756-64.
  • 13 Bakker AR. The development of an integrated and co-operative hospital information system. Med Inf 1984; 9135-42.
  • 14 Stead WW, Hammond WE. Computerized medical records. A new resource for clinical decision making. J Med Syst 1983; 7: 213-20.
  • 15 Rector AL, Nowlan W A, Kay S. Foundation for an electronic medical record. Meth Inf Med 1991; 30: 179-86.
  • 16 Grossman JH, Barnett GO, Koepsell TD. et al. An automated medical record system. JAMA 1973; 224: 1616-21.
  • 17 Whitting-O’Keefe QE, Whitting A, Henke J. The STOR clinical infonnation system. MD Comput 1988; 5: 8-21.
  • 18 Van der Lei J, Duisterhout JS, Westerhof HP. et al. The introduction of computerbased patient records in the Netherlands. Ann Intern Med 1993; 119: 1036-41.
  • 19 Vries JK, Singh J, Yount RJ. Total integration of health center information through distributed parallel processing. Proceedings of HIMSS 1994; 4: 241-52.
  • 20 Lindberg DAB. Collection, evaluation, and transmission of hospital laboratory data. Methods of Inf Med 1967; 6: 97-107.
  • 21 Whitting-O’Keefe QE, Simborg DW, Epstein WV, Warger A W. A Computerized summary medical record system can provide more infonnation than the standard medical record. JAMA 1985; 254: 1185-92.
  • 22 Bleich HL, Safran C, Slack WV. Department and laboratory computing in two hospitals. MD Comput 1989; 6: 149-55.
  • 23 Safran C, Bleich HL, Slack WV. Role of computing in patient care in two hospitals. MD Comput 1989; 6: 141-8.
  • 24 Sands DZ, Safran C, Slack WV, Bleich HL. Use of electronic mail in a teaching hospital. In: Proc Annu Symp Comput Appl Med Care 1993; 306-10.
  • 25 Horowitz GL, Bleich HL. PaperChase: a program to search the medical literature. N Engl J Med 1981; 305: 924-30.
  • 26 Bleich HL. The computer as a consultant. N Engl J Med. 1971; 284: 141-7.
  • 27 Bleich HL. Computer-based consultation: electrolyte and acid-base disorders. Am J Med 1972; 53: 285-91
  • 28 Sands DZ, Safran C. Enhancing patient care with computerized clinical formulas – the Beth Israel experience. Clin Res 1993; 41: 527A.
  • 29 Safran C, Herrmann F, Rind D, Kowaloff BA, Bleich HL, Slack WV. Computer-based support for clinical decision making. MD Comput 1990; 7: 319-22.
  • 30 Safran C, Porter D, Lightfoot J, Rury CD, Underhill LH, Bleich HL, Slack WV. ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med 1989; 11: 751-6.
  • 31 Safran C, Rury C, Rind DM, Taylor WC. A computer-based outpatient medical record for a teaching hospital. MD Comput 1991; 8: 291-9.
  • 32 Weed LL. Medical records that guide and teach. N Engl J Med. 1968; 278: 593-600.
  • 33 Weed LL. Medical Records, Medical Education, and Patient Care: the Problem Oriented Record as a Basic Tool. Cleveland Ohio: Press of Case Western Reserve; 1971
  • 34 Gross AG. The Rhetoric of Science. Cambridge Mass: Harvard University Press; 1990: 45.
  • 35 Safran C, Rind DM, Herrmann F. et al. The development of knowledge-based medical records for clinicians caring for patients with HIV infection. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O. eds. MEDINFO 92, Proceedings of the Seventh World Conference on Medical Informatics. Amsterdam: Elsevier Science Publ; 1992: 495-500.
  • 36 Rind DM, Safran C, Phillips RS. et al. Effect of computer-based alerts on the treatment and outcomes of hospitalized patients with worsening renal function. Arch Intern Med 1994; 7: 1511-7.
  • 37 Rind DM, Safran C, Phillips RS. et al. The effect of Computer-based reminders on the management of hospitalized patients with worsening renal function. In: Proceedings of the 14th Annual Symposium on Computer Applications in Medical Care. McGraw-Hill; 1991: 28-32
  • 38 Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met?. Ann Intern Med 1985; 103: 596-9.
  • 39 Van der Lei J, Musen MA, Van der Does E, Man in ’t Veld AJ, Van Bemmel JH. Comparison of computer-aided and human review of general practitioners’ management of hypertension. Lancet 1991; 338: 1504-8.
  • 40 Lindberg DAB, Humphreys BL, McCray AT. The Unified Medical language System. In: Van Bemmel JH, McCray AT. eds. Yearbook of Medical Informatics 1993. Stuttgart: Schattauer; 1993: 41-51.