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April 1, 1998

Applications of Computer-Based Clinical Guidelines

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(13):989-990. doi:10.1001/jama.279.13.989

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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