Practitioner Support

Given the volume and complexity of the information required to provide patient care, users want the patient record to be more than a repository of data. Computer-based record systems can support practitioners by providing at least five kinds of tools that are not available with paper records. These tools include mechanisms for focusing attention, for patient-specific consultation, for information management, for data analysis, and for implementing quality assurance and cost management policies.

Human cognition has measurable limitations, and as a result humans "predictably overlook rare and uncommon events" (McDonald and Tierney, 1988:3435). Automated record systems can help practitioners recognize out-of-range values or dangerous trends, remember needed actions, recall available options, and make better clinical decisions. Human memory is imperfect, especially when the task involves remembering a large set of items or recalling the same items repeatedly. The computer can be relied on to remember large numbers of items accurately and to check routinely whether the practitioner has forgotten any standard items relevant to the diagnosis or treatment of a particular problem. Some of these reminders may be critical, and they can be linked to alarms (such as beep tones or messages) that warn the practitioner before trouble occurs.13 (For example, an alarm might be triggered when two incompatible drugs are prescribed together.)

CPR systems can also provide easy access to clinical decision support systems that provide "custom-tailored assessments or advice based on sets of patient-specific data" (Shortliffe et al., 1990:469). Currently available patient-specific consultation systems suggest differential diagnoses, indicate additional information that would help to narrow the range of etiologic possibilities, suggest a single best explanation for a patient's symptoms, or provide advice on therapy (Shortliffe et al., 1990).

CPR systems can support practitioners in the patient care setting by providing easy access to knowledge and bibliographic databases. Such access will free practitioners from relying on memory for infrequently used information. Moreover, computer-based record systems can help educate practitioners and keep them up-to-date on new developments by providing access

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As discussed in Chapter 4, a significant factor to be addressed in CPR system development and implementation is the need for system users to change certain behaviors. The availability of reminders in either preventive or emergency situations will require practitioners to change their behavior; as a result, such reminders may not at first be embraced warmly by practitioners. Indeed, the value of this technology must be sufficiently demonstrated before practitioners will change their behavior.



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