Edited by Margaret A. Winker, MD, and William M. Silberg
Several studies in this issue demonstrate the powerful integrative capacity
of computer-based systems.▸ Bates and colleaguesArticle created an
electronic physician order entry system that was associated with a 55% reduction
in the rate of actual and potential adverse drug events.▸ Raschke
and colleaguesArticle evaluated a computer alert system that generated more than
1000 alerts during a 6-month study; orders were revised for 53% of the alerts.▸
McDonald and colleaguesArticle describe the technology available to create a unified
electronic medical record system on the World Wide Web that provides coordinated
access to regularly updated patient information, diagnostic images, and the
medical literature.▸ Hunt and colleaguesArticle in a review of trials
on the effectiveness of computer-based clinical decision support systems,
observe that these systems have been associated with improvements in some
aspects of physician performance, but few studies have assessed the effect
on patient outcomes. In an editorial, ClassenArticle emphasizes the need for physician
involvement in developing and assessing computer-based clinical decision support
E-mail provides new opportunities for patient-physician communication
but also raises new issues.▸ Borowitz and WyattArticle report that
consultation requests received via an online form posted on their pediatric
gastroenterology Web page required, on average, 4 minutes each for a response;
most requests were submitted by patients' parents.▸ Eysenbach
and DiepgenArticle found that only half of the physicians or Web masters from 58
dermatology Web sites responded to an unsolicited e-mail message from a fictitious
patient presenting an urgent medical problem; some responses were seriously
delayed. In related articles, SpielbergArticle discusses legal and ethical issues
related to patient-physician e-mail communication and FergusonArticle considers how
online physician services may complement traditional health care encounters.
Is computerized medical information useful for obtaining evidence to
support clinical decision-making during the clinical encounter?▸
Sackett and StrausArticle report that evidence from the medical literature was identified
and applied during clinical teaching rounds using computerized and print resources
on a readily available evidence cart, but fewer searches for evidence to answer
clinical questions were performed after the cart was removed.▸
Hersh and HickamArticle in a systematic review of studies that evaluated information
retrieval systems, found that the use of current systems in patient care settings
is limited, the recovery of relevant information is incomplete, and little
is known about the impact of these systems on physician behavior and patient
outcomes. In an editorial, Hubbs and colleaguesArticle argue that ready access to
online medical information must be accompanied by an increased willingness
by physicians to seek information when they need it.
"Although the message is sometimes ambiguous and unreliable, pleasure
can be had in the hunt for the meaning." Richard Diebenkorn, Berkeley No. 8, 1954, American.
"How might the world work when most patients and most physicians are
online?" From "The X Factor."
Telecommunications technology enables physicians in out-of-the-way places
to link with their colleagues anywhere around the globe.
The development of computerized medical information systems is outpacing
Tips for physicians who want to create their own Web site.
Eng and colleagues call for universal access to communication and information
For your patients: Finding health information on the Internet.
This Week in JAMA. JAMA. 1998;280(15):1291. doi:10.1001/jama.280.15.1291