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Academia and the Profession |

Reminders to Physicians from an Introspective Computer Medical Record: A Two-Year Randomized Trial

CLEMENT J. McDONALD, M.D.; SIU L. HUI, Ph.D.; DAVID M. SMITH, M.D.; WILLIAM M. TIERNEY, M.D.; STUART J. COHEN, Ed.D.; MORRIS WEINBERGER, Ph.D.; and GEORGE P. McCABE, Ph.D.
[+] Article and Author Information

Grant support: in part by grants DHHS 02485 and DHHS 04090 from the National Center for Health Services Research, and grant PHS P60 AM 20542 from the National Institute for Arthritis, Metabolism and Digestive Diseases.

▸Requests for reprints should be addressed to Clement J. McDonald, M.D.; Regenstrief Institute, 1001 West Tenth Street; Indianapolis, IN 46202.


Indianapolis, Indiana; and Lafayette, Indiana.


© 1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;100(1):130-138. doi:10.7326/0003-4819-100-1-130
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We developed a computer-stored medical record system containing a limited set of the total clinical data base—primarily diagnostic studies and treatments. This system responds to its own content according to physician-authored reminder rules. To determine the effect of the reminder messages generated by 1490 rules on physician behavior, we randomly assigned practitioners in a general medicine clinic to study or control groups. The computer found indications for six different actions per patient in 12 467 patients during a 2-year study: 61 study group residents who received computer reminders responded to 49% of these indications; 54 control group residents, to only 29% (p < 0.0001). Preventive care (occult blood testing, mammographic screening, weight reduction diets, influenza and pneumococcal vaccines) was affected. The intentions of the study group to use a given action for an indication predicted their response to the indications (p < 0.03, r2 = 0.33). The intentions of the control residents did not.

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