Changing The Doctor-patient Relationship

Can computerised decision support systems deliver improved quality in primary care?

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7220.1281 (Published 13 November 1999) Cite this as: BMJ 1999;319:1281
  1. Brendan C Delaney, senior lecturer (b.c.delaney@bham.ac.uk),
  2. David A Fitzmaurice, senior lecturer,
  3. Amjid Riaz, clinical research fellow,
  4. F D Richard Hobbs, professor
  1. Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham B15 2TT
  1. Correspondence to: B C Delaney

    Computerised decision support systems or “expert systems” are computer software systems that are designed to aid clinical decision making Computerised decision support has been defined as provision of assessments or prompts specific to the patient and selected from a knowledge base on the basis of individual patient data.1 At its simplest this definition will include programs that suggest alternatives for treatment or diagnosis on the basis of a simple algorithm. More complex systems model the likelihood of future events and the effectiveness of proposed interventions based on individual patient data and “knowledge” of risks and the effectiveness of interventions.2

    Primary care more than any other specialty is characterised by uncertainty This is not only because it is the first point of contact and the recipient of undifferentiated problems, but also because primary care has the role of monitoring and providing optimal continuing care for many common chronic conditions. Improvement of quality by a reduction of the variation in primary care practice is a key component of UK national health policy.3 Computerised decision support systems have potential to drive reminders, provide alerts for prescribing interactions or test results, interpret complex investigations (or electrocardiograms), predict mortality on the basis of epidemiological data, aid diagnosis, and calculate drug doses. The question examined by this review is how may computerised decision support systems contribute to improving quality in primarycare?

    Summary points

    Computerised reminder and recall systems increase the frequency of monitoring and preventive tasks in the management of chronic disease

    Computerised dosing systems for warfarin improve the control of anticoagulation

    Computerised diagnostic decision support has not yet been developed to the stage where it can significantly aid diagnostic accuracy

    There is a lack of research with patient oriented outcomes in this topic

    Shared decision making between doctors and patients is an issue where …

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