To the Editor.—The well-executed study
by Dr Schriger and colleagues1provides
an elegant demonstration of a "switching effect" associated with computerized
prompting systems: switch the computerized decision support on and physician
performance improves; switch it off and performance returns to baseline. The
related observation that physician behavior actually deteriorated below baseline
for test ordering and treatment when the computerized support was switched
off suggests that physicians exposed to such support become at least partially
dependent on it. Since physicians exposed to such systems may move on to practice
in environments without similar system support, this effect may be responsible
for a significant unintentional adverse effect on physician performance and
should be characterized further.
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