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June 17, 1988, Vol 259, No. 23 >
ARTICLE | June 17, 1988

Computer-Stored Medical Records: Title and subTitle BreakTheir Future Role in Medical Practice FREE

Clement J. McDonald, MD; William M. Tierney, MD
[+] Author Affiliations

Reprint requests to Regenstrief Institute for Health Care, 1001 W Tenth St, Indianapolis, IN 46202 (Dr McDonald).


JAMA. 1988;259(23):3433-3440. doi:10.1001/jama.1988.03720230043028
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References

Over the next few years, computer-stored medical records will become technically and economically feasible on a broad scale. Hybrid systems that include computer and traditional paper versions of the medical record and obtain their data from existing ancillary service systems will soon be widely available. Completely electronic medical records will follow. However, standards for exchanging clinical information between independent computers are needed to eliminate the reentry or interfacing costs otherwise required to obtain data from computerized ancillary services. Three kinds of benefits may be expected: (1) improved logistics and organization of the medical record to speed care and improve care givers' efficiency, (2) automatic computer review of the medical record to limit errors and control costs, and (3) systematic analysis of past clinical experience to guide future practices and policies.

(JAMA 1988;259:3433-3440)

REFERENCES

1 +
McGowan PF, Smith E, Hilgers WB:  Computer assisted legal research: Now a necessity. Tex Bar J 1987;;50:746-748.
2 +
Hammond WE, Stead WW:  The evolution of a computerized medical information system. Proceedings of the Tenth Annual Symposium on Computer Applications in Medical Care , Washington, DC, Oct 25-26, 1986;, pp 147-156.
3 +
Pryor TA, Gardner RM, Clayton PD, et al:  The HELP systems. J Med Sys 1985;;7:87-102.
4 +
Barnett GO:  The application of computer-based medical-record systems in ambulatory practice. N Engl J Med 1984;;310:1643-1650.
5 +
Whiting-O'Keefe QE, Simborg DW, Epstein WV, et al:  A computerized summary medical record system can produce more information than the standard medical record. JAMA 1985;;254:1185-1192.
6 +
Bleich HL, Beckly RF, Horowitz GL, et al:  Clinical computing in a teaching hospital. N Engl J Med 1985;;312:756-764.
7 +
McDonald CJ, Blevins L, Glazener T, et al:  Data base management, feedback control, and the Regenstrief medical record. J Med Sys 1983;;7:111-125.
8 +
Darnell JC, Hiner SL, Neill PJ, et al:  After-hours telephone access to physicians with access to computerized medical records. Med Care 1985;;-23:20-26.
9 +
Shabot MM:  Software for computers and calculators in critical care medicine. Software in Healthcare , (February-March) 1985;, pp 26-39.
10 +
McDonald CJ, Tierney WM:  The medical gopher: A microcomputer system to help find, organize and decide about patient data. West J Med 1986;;12:823-829.
11 +
De Zegher-Geets IM, Freeman AG, Walker MG, et al:  Intelligent summarization and display of on-line medical records. MD Computing (May-June) 1988;, pp 45-54.
12 +
Fries JF:  Alternatives in medical record formats. Med Care 1974;;12:871-881.
13 +
Pauker SG, Kassirer JP:  The threshold approach to clinical decision making. N Engl J Med 1980;;302:1109-1117.
14 +
Wilson GA, McDonald CJ, McCabe GP:  The effect of immediate access to a computerized medical record on physician test ordering: A controlled clinical trial in the emergency room. Am J Public Health 1982;;72:698-702.
15 +
Tierney WM, McDonald CJ, Martin DK, et al:  Computerized display of past test results: Effect on outpatient testing. Ann Intern Med 1987;;107:569-574.
16 +
Alluisi EA:  Attention and vigilance as mechanisms of response , in Bilodeau EA (ed): Acquisition of Skill . Orlando, Fla, Academic Press Inc, 1966;, pp 201-213.
17 +
Craven RB, Wenzel RP, Atuk NO:  Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;;82:628-632.
18 +
Cole RB, Balmer JP, Wilson TS:  Surveillance of elderly hospital patients for pulmonary tuberculosis. Br Med J 1974;;1:104-106.
19 +
Shapiro S, Slone D, Lewis GP, et al:  Fatal drug reactions among medical inpatients. JAMA 1971;;216:467-472.
20 +
Drinkwater BL:  Performance of civil aviation pilots under conditions of sensory input overload. Aerospace Med 1967;;38:164-168.
21 +
Shortliffe EH:  Computer programs to support clinical decision making. JAMA 1987;;258:61-66.
22 +
Walton JD, Musen MA, Combs DM, et al:  Graphical access to medical expert systems: III. Design of a knowledge-acquisition environment. Methods Inf Med 1987;;26:78-88.
23 +
Barnett GO, Winickoff R, Dorsey JL, et al:  Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med Care 1978;;16:962-970.
24 +
Winickoff RN, Coltin KL, Fleishman SJ, et al:  Semiautomated reminder system for improving syphilis management. J Gen Intern Med 1986;;1:78-84.
25 +
Hulse RK, Clark SJ, Jackson JC, et al:  Computerized medication monitoring system. Am J Hosp Pharm 1976;;33:1061-1064.
26 +
Evans RS, Larsen RA, Burk JP, et al:  Computer surveillance of hospital-acquired infection and antibiotic use. JAMA 1986;;256:1007-1011.
27 +
McDonald CJ: Action-Oriented Decisions in Ambulatory Medicine . Chicago, Year Book Medical Publishers Inc, 1981;.
28 +
McDonald CJ, Hui SL, Smith DM, et al:  Reminders to physicians from an introspective computer medical record. Ann Intern Med 1984;;100:130-138.
29 +
O'Malley MS, Fletcher SW, Knight BK, et al:  Manual and computer prompting for health maintenance procedures, abstracted. Clin Res 1987;;35:91A.
30 +
Cohen DI, Littenberg B, Wetzel C, et al:  Improving physician compliance with preventive medicine guidelines. Med Care 1982;;20:1040-1045.
31 +
Westenskow DR:  Automating patient care with closed-loop control. MD Computing (March-April) 1986;, pp 14-20.
32 +
Sheppard LC, Kouchoukos NT, Kurtts MA, et al:  Automated treatment of critically ill patients following operation. Ann Surg 1968;;168:596-604.
33 +
Meline LJ, Westenskow DR, Pace ML:  Computer controlled regulation of sodium nitroprusside infusion. Anesth Analg 1985;;64:38-42.
34 +
Trotman RE, Meldrum SJ (eds):  Modular labour-management system. J Med Eng Technol 1982;;6:89-92.
35 +
McDonald CJ, Hui SL, Tierney WM:  Diuretic-induced laboratory abnormalities that predict ventricular ectopy. J Chronic Dis 1986;;39:127-135.
36 +
Tierney WM, Martin DK, Greenlee MC, et al:  The prognosis of hyponatremia at hospital admission. J Gen Intern Med 1986;;1:380-385.
37 +
Psaty BM, Tierney WM, Martin DK, et al:  The value of serum iron studies as a test for iron-deficiency anemia in a county hospital. J Gen Intern Med 1987;;2:160-167.
38 +
Lee KL, Pryor DB, Harrell FE, et al:  Predicting outcome in coronary disease: Statistical models versus expert clinicians. Am J Med 1986;;80:553-560.
39 +
Fries JF, Spitz PW, Mitchell DM, et al:  Impact of specific therapy upon rheumatoid arthritis. Arth Rheum 1986;;29:620-627.
40 +
Jick H, Walker AM, Spriet-Pourra C:  Postmarketing follow-up. JAMA 1979;;242:2310-2314.
41 +
McNeer JF, Wagner GS, Ginsburg PB, et al:  Hospital discharge one week after acute myocardial infarction. N Engl J Med 1978;;298:229-232.
42 +
Mulley AG, Thibault GE, Hughes RA, et al:  The course of patients with suspected myocardial infarction: The identification of low risk patients for early transfer from intensive care. N Engl J Med 1980;;302:943-947.
43 +
Tierney WM, McDonald CJ, McCabe G:  Serum potassium testing in diuretic-treated outpatients: A multivariate approach. Med Decis Making 1985;;5:89-104.
44 +
Komaroff AL:  Variability in medical practice: An investigative opportunity for general medicine. J Gen Intern Med 1986;;1( (suppl) ):S31-S34.
45 +
Dittus RS, Tierney WM:  Scheduling follow-up office visits: Physician variability, abstracted. Clin Res 1987;;35:738A.
46 +
Safran C, Sobel E, Lightfoot J, et al:  A computer program for interactive searching of a medical database , in Salamon R, Blum B, Jorgenson M (eds): MEDINFO 86: Proceedings of the Fifth Conference on Medical Informatics . New York, Elsevier Science Publishing Co Inc, 1986;, pp 545-549.
47 +
Pryor DB, Harrell FE, Lee KL, et al:  Estimating likelihood of significant coronary artery disease. Am J Med 1983;;75:771-780.
48 +
Lundsgaarde HP, Fischer PJ, Steele DJ:  Human problems in computerized medicine , in Squier RJ (ed): Publications in Anthropology, 13 . Lawrence, Kan, University of Kansas, 1981;.
49 +
ASTM Subcommittee E1238-1288: A Standard Specification for Transferring Clinical Laboratory Data Messages Between Independent Computer Systems . Philadelphia, The American Society for Testing and Materials, April 1988;.
50 +
Digital Imaging and Communications , American College of Radiology—National Electrical Manufacturers Association standards publication 300-1985. Washington, DC, National Electrical Manufacturers Association, 1985;.
51 +
Polacsek RA:  The fourth annual medical software buyer's guide. MD Computing (November-December) 1987;, pp 23-136.
52 +
Gould JD, Grischkowsky N: Doing the Same Work With Hardcopy and Cathode Ray Tube (CRT) Computer Terminals , IBM Research Report RC 9849 (43361). Yorktown Heights, NY, IBM Research Center, Jan 20, 1983;.
53 +
McDonald CJ, Flick G:  Observations and opinions: Voice input revisited. MD Computing (November-December) 1987;, pp 12-16.
54 +
McDonald CJ:  Observations and opinions: More on voice-input devices. MD Computing (January-February) 1987;, pp 11-12.
55 +
Mamlin JJ, Baker DH:  Combined time-motion and work sampling study in a general medicine clinic. Med Care 1973;;11:449-456.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
McGowan PF, Smith E, Hilgers WB:  Computer assisted legal research: Now a necessity. Tex Bar J 1987;;50:746-748.
2 +
Hammond WE, Stead WW:  The evolution of a computerized medical information system. Proceedings of the Tenth Annual Symposium on Computer Applications in Medical Care , Washington, DC, Oct 25-26, 1986;, pp 147-156.
3 +
Pryor TA, Gardner RM, Clayton PD, et al:  The HELP systems. J Med Sys 1985;;7:87-102.
4 +
Barnett GO:  The application of computer-based medical-record systems in ambulatory practice. N Engl J Med 1984;;310:1643-1650.
5 +
Whiting-O'Keefe QE, Simborg DW, Epstein WV, et al:  A computerized summary medical record system can produce more information than the standard medical record. JAMA 1985;;254:1185-1192.
6 +
Bleich HL, Beckly RF, Horowitz GL, et al:  Clinical computing in a teaching hospital. N Engl J Med 1985;;312:756-764.
7 +
McDonald CJ, Blevins L, Glazener T, et al:  Data base management, feedback control, and the Regenstrief medical record. J Med Sys 1983;;7:111-125.
8 +
Darnell JC, Hiner SL, Neill PJ, et al:  After-hours telephone access to physicians with access to computerized medical records. Med Care 1985;;-23:20-26.
9 +
Shabot MM:  Software for computers and calculators in critical care medicine. Software in Healthcare , (February-March) 1985;, pp 26-39.
10 +
McDonald CJ, Tierney WM:  The medical gopher: A microcomputer system to help find, organize and decide about patient data. West J Med 1986;;12:823-829.
11 +
De Zegher-Geets IM, Freeman AG, Walker MG, et al:  Intelligent summarization and display of on-line medical records. MD Computing (May-June) 1988;, pp 45-54.
12 +
Fries JF:  Alternatives in medical record formats. Med Care 1974;;12:871-881.
13 +
Pauker SG, Kassirer JP:  The threshold approach to clinical decision making. N Engl J Med 1980;;302:1109-1117.
14 +
Wilson GA, McDonald CJ, McCabe GP:  The effect of immediate access to a computerized medical record on physician test ordering: A controlled clinical trial in the emergency room. Am J Public Health 1982;;72:698-702.
15 +
Tierney WM, McDonald CJ, Martin DK, et al:  Computerized display of past test results: Effect on outpatient testing. Ann Intern Med 1987;;107:569-574.
16 +
Alluisi EA:  Attention and vigilance as mechanisms of response , in Bilodeau EA (ed): Acquisition of Skill . Orlando, Fla, Academic Press Inc, 1966;, pp 201-213.
17 +
Craven RB, Wenzel RP, Atuk NO:  Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;;82:628-632.
18 +
Cole RB, Balmer JP, Wilson TS:  Surveillance of elderly hospital patients for pulmonary tuberculosis. Br Med J 1974;;1:104-106.
19 +
Shapiro S, Slone D, Lewis GP, et al:  Fatal drug reactions among medical inpatients. JAMA 1971;;216:467-472.
20 +
Drinkwater BL:  Performance of civil aviation pilots under conditions of sensory input overload. Aerospace Med 1967;;38:164-168.
21 +
Shortliffe EH:  Computer programs to support clinical decision making. JAMA 1987;;258:61-66.
22 +
Walton JD, Musen MA, Combs DM, et al:  Graphical access to medical expert systems: III. Design of a knowledge-acquisition environment. Methods Inf Med 1987;;26:78-88.
23 +
Barnett GO, Winickoff R, Dorsey JL, et al:  Quality assurance through automated monitoring and concurrent feedback using a computer-based medical information system. Med Care 1978;;16:962-970.
24 +
Winickoff RN, Coltin KL, Fleishman SJ, et al:  Semiautomated reminder system for improving syphilis management. J Gen Intern Med 1986;;1:78-84.
25 +
Hulse RK, Clark SJ, Jackson JC, et al:  Computerized medication monitoring system. Am J Hosp Pharm 1976;;33:1061-1064.
26 +
Evans RS, Larsen RA, Burk JP, et al:  Computer surveillance of hospital-acquired infection and antibiotic use. JAMA 1986;;256:1007-1011.
27 +
McDonald CJ: Action-Oriented Decisions in Ambulatory Medicine . Chicago, Year Book Medical Publishers Inc, 1981;.
28 +
McDonald CJ, Hui SL, Smith DM, et al:  Reminders to physicians from an introspective computer medical record. Ann Intern Med 1984;;100:130-138.
29 +
O'Malley MS, Fletcher SW, Knight BK, et al:  Manual and computer prompting for health maintenance procedures, abstracted. Clin Res 1987;;35:91A.
30 +
Cohen DI, Littenberg B, Wetzel C, et al:  Improving physician compliance with preventive medicine guidelines. Med Care 1982;;20:1040-1045.
31 +
Westenskow DR:  Automating patient care with closed-loop control. MD Computing (March-April) 1986;, pp 14-20.
32 +
Sheppard LC, Kouchoukos NT, Kurtts MA, et al:  Automated treatment of critically ill patients following operation. Ann Surg 1968;;168:596-604.
33 +
Meline LJ, Westenskow DR, Pace ML:  Computer controlled regulation of sodium nitroprusside infusion. Anesth Analg 1985;;64:38-42.
34 +
Trotman RE, Meldrum SJ (eds):  Modular labour-management system. J Med Eng Technol 1982;;6:89-92.
35 +
McDonald CJ, Hui SL, Tierney WM:  Diuretic-induced laboratory abnormalities that predict ventricular ectopy. J Chronic Dis 1986;;39:127-135.
36 +
Tierney WM, Martin DK, Greenlee MC, et al:  The prognosis of hyponatremia at hospital admission. J Gen Intern Med 1986;;1:380-385.
37 +
Psaty BM, Tierney WM, Martin DK, et al:  The value of serum iron studies as a test for iron-deficiency anemia in a county hospital. J Gen Intern Med 1987;;2:160-167.
38 +
Lee KL, Pryor DB, Harrell FE, et al:  Predicting outcome in coronary disease: Statistical models versus expert clinicians. Am J Med 1986;;80:553-560.
39 +
Fries JF, Spitz PW, Mitchell DM, et al:  Impact of specific therapy upon rheumatoid arthritis. Arth Rheum 1986;;29:620-627.
40 +
Jick H, Walker AM, Spriet-Pourra C:  Postmarketing follow-up. JAMA 1979;;242:2310-2314.
41 +
McNeer JF, Wagner GS, Ginsburg PB, et al:  Hospital discharge one week after acute myocardial infarction. N Engl J Med 1978;;298:229-232.
42 +
Mulley AG, Thibault GE, Hughes RA, et al:  The course of patients with suspected myocardial infarction: The identification of low risk patients for early transfer from intensive care. N Engl J Med 1980;;302:943-947.
43 +
Tierney WM, McDonald CJ, McCabe G:  Serum potassium testing in diuretic-treated outpatients: A multivariate approach. Med Decis Making 1985;;5:89-104.
44 +
Komaroff AL:  Variability in medical practice: An investigative opportunity for general medicine. J Gen Intern Med 1986;;1( (suppl) ):S31-S34.
45 +
Dittus RS, Tierney WM:  Scheduling follow-up office visits: Physician variability, abstracted. Clin Res 1987;;35:738A.
46 +
Safran C, Sobel E, Lightfoot J, et al:  A computer program for interactive searching of a medical database , in Salamon R, Blum B, Jorgenson M (eds): MEDINFO 86: Proceedings of the Fifth Conference on Medical Informatics . New York, Elsevier Science Publishing Co Inc, 1986;, pp 545-549.
47 +
Pryor DB, Harrell FE, Lee KL, et al:  Estimating likelihood of significant coronary artery disease. Am J Med 1983;;75:771-780.
48 +
Lundsgaarde HP, Fischer PJ, Steele DJ:  Human problems in computerized medicine , in Squier RJ (ed): Publications in Anthropology, 13 . Lawrence, Kan, University of Kansas, 1981;.
49 +
ASTM Subcommittee E1238-1288: A Standard Specification for Transferring Clinical Laboratory Data Messages Between Independent Computer Systems . Philadelphia, The American Society for Testing and Materials, April 1988;.
50 +
Digital Imaging and Communications , American College of Radiology—National Electrical Manufacturers Association standards publication 300-1985. Washington, DC, National Electrical Manufacturers Association, 1985;.
51 +
Polacsek RA:  The fourth annual medical software buyer's guide. MD Computing (November-December) 1987;, pp 23-136.
52 +
Gould JD, Grischkowsky N: Doing the Same Work With Hardcopy and Cathode Ray Tube (CRT) Computer Terminals , IBM Research Report RC 9849 (43361). Yorktown Heights, NY, IBM Research Center, Jan 20, 1983;.
53 +
McDonald CJ, Flick G:  Observations and opinions: Voice input revisited. MD Computing (November-December) 1987;, pp 12-16.
54 +
McDonald CJ:  Observations and opinions: More on voice-input devices. MD Computing (January-February) 1987;, pp 11-12.
55 +
Mamlin JJ, Baker DH:  Combined time-motion and work sampling study in a general medicine clinic. Med Care 1973;;11:449-456.

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