Skip to main content
PMC home page
Journal of the American Medical Informatics Association : JAMIA logoLink to Journal of the American Medical Informatics Association : JAMIA
. 1995 Sep-Oct;2(5):316–322. doi: 10.1136/jamia.1995.96073834

Computerizing guidelines to improve care and patient outcomes: the example of heart failure.

W M Tierney 1, J M Overhage 1, B Y Takesue 1, L E Harris 1, M D Murray 1, D L Vargo 1, C J McDonald 1
PMCID: PMC116272  PMID: 7496881

Abstract

Increasing amounts of medical knowledge, clinical data, and patient expectations have created a fertile environment for developing and using clinical practice guidelines. Electronic medical records have provided an opportunity to invoke guidelines during the everyday practice of clinical medicine to improve health care quality and control costs. In this paper, efforts to incorporate complex guidelines [those for heart failure from the Agency for Health Care Policy and Research (AHCPR)] into a network of physicians' interactive microcomputer workstations are reported. The task proved difficult because the guidelines often lack explicit definitions (e.g., for symptom severity and adverse events) that are necessary to navigate the AHCPR algorithm. They also focus more on errors of omission (not doing the right thing) than on errors of commission (doing the wrong thing) and do not account for comorbid conditions, concurrent drug therapy, or the timing of most interventions and follow-up. As they stand, the heart failure guidelines give good general guidance to individual practitioners, but cannot be used to assess quality or care without extensive "translation" into the local environment. Specific recommendations are made so that future guidelines will prove useful to a wide range of prospective users.

Full Text

The Full Text of this article is available as a PDF (959.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnett G. O., Cimino J. J., Hupp J. A., Hoffer E. P. DXplain. An evolving diagnostic decision-support system. JAMA. 1987 Jul 3;258(1):67–74. doi: 10.1001/jama.258.1.67. [DOI] [PubMed] [Google Scholar]
  2. Berwick D. M. Continuous improvement as an ideal in health care. N Engl J Med. 1989 Jan 5;320(1):53–56. doi: 10.1056/NEJM198901053200110. [DOI] [PubMed] [Google Scholar]
  3. Cheng T. O. Congestive heart failure in coronary artery disease. Am J Med. 1991 Oct;91(4):409–415. doi: 10.1016/0002-9343(91)90159-u. [DOI] [PubMed] [Google Scholar]
  4. Feigenbaum H. Clinical applications of echocardiography. Prog Cardiovasc Dis. 1972 May;14(6):531–558. doi: 10.1016/0033-0620(72)90007-2. [DOI] [PubMed] [Google Scholar]
  5. Guyatt G. H., Nogradi S., Halcrow S., Singer J., Sullivan M. J., Fallen E. L. Development and testing of a new measure of health status for clinical trials in heart failure. J Gen Intern Med. 1989 Mar-Apr;4(2):101–107. doi: 10.1007/BF02602348. [DOI] [PubMed] [Google Scholar]
  6. Haynes R. B., McKibbon K. A., Fitzgerald D., Guyatt G. H., Walker C. J., Sackett D. L. How to keep up with the medical literature: V. Access by personal computer to the medical literature. Ann Intern Med. 1986 Nov;105(5):810–816. doi: 10.7326/0003-4819-105-5-810. [DOI] [PubMed] [Google Scholar]
  7. McDonald C. J., Hui S. L., Smith D. M., Tierney W. M., Cohen S. J., Weinberger M., McCabe G. P. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984 Jan;100(1):130–138. doi: 10.7326/0003-4819-100-1-130. [DOI] [PubMed] [Google Scholar]
  8. McDonald C. J., Overhage J. M. Guidelines you can follow and can trust. An ideal and an example. JAMA. 1994 Mar 16;271(11):872–873. [PubMed] [Google Scholar]
  9. McDonald C. J., Tierney W. M. Computer-stored medical records. Their future role in medical practice. JAMA. 1988 Jun 17;259(23):3433–3440. [PubMed] [Google Scholar]
  10. McDonald C. J., Tierney W. M., Overhage J. M., Martin D. K., Wilson G. A. The Regenstrief Medical Record System: 20 years of experience in hospitals, clinics, and neighborhood health centers. MD Comput. 1992 Jul-Aug;9(4):206–217. [PubMed] [Google Scholar]
  11. McDonald C. J., Tierney W. M. The Medical Gopher--a microcomputer system to help find, organize and decide about patient data. West J Med. 1986 Dec;145(6):823–829. [PMC free article] [PubMed] [Google Scholar]
  12. Miller R., Masarie F. E., Myers J. D. Quick medical reference (QMR) for diagnostic assistance. MD Comput. 1986 Sep-Oct;3(5):34–48. [PubMed] [Google Scholar]
  13. Tierney W. M., McDonald C. J., Hui S. L., Martin D. K. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988 Feb 26;259(8):1194–1198. [PubMed] [Google Scholar]
  14. Tierney W. M., McDonald C. J., Martin D. K., Rogers M. P. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987 Oct;107(4):569–574. doi: 10.7326/0003-4819-107-4-569. [DOI] [PubMed] [Google Scholar]
  15. Tierney W. M., Miller M. E., McDonald C. J. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990 May 24;322(21):1499–1504. doi: 10.1056/NEJM199005243222105. [DOI] [PubMed] [Google Scholar]
  16. Tierney W. M., Miller M. E., Overhage J. M., McDonald C. J. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993 Jan 20;269(3):379–383. [PubMed] [Google Scholar]

Articles from Journal of the American Medical Informatics Association are provided here courtesy of Oxford University Press

RESOURCES