Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
In Reply.—Although we share the enthusiasm
of Drs Elson and Connelly for the use of informatics to improve patient care,
2 of the points they raise deserve comment. First, Elson and Connelly question
our assertion that "few empirical data exist about the effect of computer-based
systems for the application of clinical guidelines on the quality of care."
The disagreement is largely semantic. By "clinical guidelines," we were referring
to the comprehensive complaint-specific or disease-specific guidelines issued
by groups such as the Agency for Health Care Policy and Research and specialty
societies. With the exception of the work by the Regenstreif group on the
heart failure guideline,1 there has been
little investigation of the implementation of guidelines that make recommendations
regarding all aspects of care for a specific clinical problem. Most of the
trials cited in references 2 and 3 of their letter focus on smaller, function-specific
guidelines. Typical interventions either assist in a specific task (test or
antibiotic ordering, the decision to hospitalize) or provide reminders for
a specific situation ("this patient needs a cholesterol test today").
Schriger DL, Baraff LJ, Rogers WH, Cretin S. Applications of Computer-Based Clinical Guidelines—Reply. JAMA. 1998;279(13):989–990. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-13-jbk0401
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