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April 1, 1998

Applications of Computer-Based Clinical Guidelines—Reply

Author Affiliations

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

JAMA. 1998;279(13):989-990. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-13-jbk0401

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").