Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1998 May;168(5):311–318.

Strategies and methods for aligning current and best medical practices. The role of information technologies.

E C Schneider 1, J M Eisenberg 1
PMCID: PMC1304973  PMID: 9614787

Abstract

Rapid change in American medicine requires that physicians adjust established behaviors and acquire new skills. In this article, we address three questions: What do we know about how to change physicians' practices? How can physicians take advantage of new and evolving information technologies that are likely to have an impact on the future practice of medicine? and What strategic educational interventions will best enable physicians to show competencies in information management and readiness to change practice? We outline four guiding principles for incorporating information systems tools into both medical education and practice, and we make eight recommendations for the development of a new medical school curriculum. This curriculum will produce a future medical practitioner who is capable of using information technologies to systematically measure practice performance, appropriateness, and effectiveness while updating knowledge efficiently.

Full text

PDF

Selected References

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

  1. Avorn J., Soumerai S. B. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med. 1983 Jun 16;308(24):1457–1463. doi: 10.1056/NEJM198306163082406. [DOI] [PubMed] [Google Scholar]
  2. Barry M. J., Fowler F. J., Jr, Mulley A. G., Jr, Henderson J. V., Jr, Wennberg J. E. Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care. 1995 Aug;33(8):771–782. doi: 10.1097/00005650-199508000-00003. [DOI] [PubMed] [Google Scholar]
  3. Berner E. S., Webster G. D., Shugerman A. A., Jackson J. R., Algina J., Baker A. L., Ball E. V., Cobbs C. G., Dennis V. W., Frenkel E. P. Performance of four computer-based diagnostic systems. N Engl J Med. 1994 Jun 23;330(25):1792–1796. doi: 10.1056/NEJM199406233302506. [DOI] [PubMed] [Google Scholar]
  4. 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]
  5. Byrne A. J., Hilton P. J., Lunn J. N. Basic simulations for anaesthetists. A pilot study of the ACCESS system. Anaesthesia. 1994 May;49(5):376–381. doi: 10.1111/j.1365-2044.1994.tb03466.x. [DOI] [PubMed] [Google Scholar]
  6. Chi-Lum B. I., Lundberg G. D., Silberg W. M. Physicians accessing the Internet, the PAI Project. An educational initiative. JAMA. 1996 May 1;275(17):1361–1362. [PubMed] [Google Scholar]
  7. Chodorow S. Educators must take the electronic revolution seriously. Acad Med. 1996 Mar;71(3):221–226. doi: 10.1097/00001888-199603000-00009. [DOI] [PubMed] [Google Scholar]
  8. Chopra V., Gesink B. J., de Jong J., Bovill J. G., Spierdijk J., Brand R. Does training on an anaesthesia simulator lead to improvement in performance? Br J Anaesth. 1994 Sep;73(3):293–297. doi: 10.1093/bja/73.3.293. [DOI] [PubMed] [Google Scholar]
  9. Cimino J. J., Socratous S. A., Clayton P. D. Internet as clinical information system: application development using the World Wide Web. J Am Med Inform Assoc. 1995 Sep-Oct;2(5):273–284. doi: 10.1136/jamia.1995.96073829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Classen D. C., Pestotnik S. L., Evans R. S., Burke J. P. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991 Nov 27;266(20):2847–2851. [PubMed] [Google Scholar]
  11. Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. doi: 10.1001/jama.274.9.700. [DOI] [PubMed] [Google Scholar]
  12. Everitt D. E., Soumerai S. B., Avorn J., Klapholz H., Wessels M. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders. Infect Control Hosp Epidemiol. 1990 Nov;11(11):578–583. doi: 10.1086/646098. [DOI] [PubMed] [Google Scholar]
  13. Fihn S. D., McDonell M. B., Vermes D., Henikoff J. G., Martin D. C., Callahan C. M., Kent D. L., White R. H. A computerized intervention to improve timing of outpatient follow-up: a multicenter randomized trial in patients treated with warfarin. National Consortium of Anticoagulation Clinics. J Gen Intern Med. 1994 Mar;9(3):131–139. doi: 10.1007/BF02600026. [DOI] [PubMed] [Google Scholar]
  14. Frisse M. E., Braude R. M., Florance V., Fuller S. Informatics and medical libraries: changing needs and changing roles. Acad Med. 1995 Jan;70(1):30–35. doi: 10.1097/00001888-199501000-00010. [DOI] [PubMed] [Google Scholar]
  15. Galvin J. R., D'Alessandro M. P., Erkonen W. E., Smith W. L., el-Khoury G. Y., Weinstein J. N. The virtual hospital. Providing multimedia decision support tools via the Internet. Spine (Phila Pa 1976) 1995 Aug 1;20(15):1735–1738. [PubMed] [Google Scholar]
  16. Genesen L., Sharp H. M., Genesen M. C. Faxing medical records: another threat to confidentiality in medicine. JAMA. 1994 May 11;271(18):1401–1402. [PubMed] [Google Scholar]
  17. Glowniak J. V., Bushway M. K. Computer networks as a medical resource. Accessing and using the Internet. JAMA. 1994 Jun 22;271(24):1934–1939. [PubMed] [Google Scholar]
  18. Gostin L. O., Lazzarini Z., Neslund V. S., Osterholm M. T. The public health information infrastructure. A national review of the law on health information privacy. JAMA. 1996 Jun 26;275(24):1921–1927. [PubMed] [Google Scholar]
  19. Greco P. J., Eisenberg J. M. Changing physicians' practices. N Engl J Med. 1993 Oct 21;329(17):1271–1273. doi: 10.1056/NEJM199310213291714. [DOI] [PubMed] [Google Scholar]
  20. Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
  21. Hannan E. L., Kilburn H., Jr, Racz M., Shields E., Chassin M. R. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994 Mar 9;271(10):761–766. [PubMed] [Google Scholar]
  22. Hunter I. W., Jones L. A., Sagar M. A., Lafontaine S. R., Hunter P. J. Ophthalmic microsurgical robot and associated virtual environment. Comput Biol Med. 1995 Mar;25(2):173–182. doi: 10.1016/0010-4825(94)00042-o. [DOI] [PubMed] [Google Scholar]
  23. Johnston M. E., Langton K. B., Haynes R. B., Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. doi: 10.7326/0003-4819-120-2-199401150-00007. [DOI] [PubMed] [Google Scholar]
  24. Leape L. L., Bates D. W., Cullen D. J., Cooper J., Demonaco H. J., Gallivan T., Hallisey R., Ives J., Laird N., Laffel G. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA. 1995 Jul 5;274(1):35–43. [PubMed] [Google Scholar]
  25. Lilienfield L. S., Broering N. C. Computers as teachers: learning from animations. Am J Physiol. 1994 Jun;266(6 Pt 3):S47–S54. doi: 10.1152/advances.1994.266.6.S47. [DOI] [PubMed] [Google Scholar]
  26. Massaro T. A. Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior. Acad Med. 1993 Jan;68(1):20–25. doi: 10.1097/00001888-199301000-00003. [DOI] [PubMed] [Google Scholar]
  27. Massaro T. A. Introducing physician order entry at a major academic medical center: II. Impact on medical education. Acad Med. 1993 Jan;68(1):25–30. doi: 10.1097/00001888-199301000-00004. [DOI] [PubMed] [Google Scholar]
  28. 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]
  29. McDonald C. J., Hui S. L., Zhou X. H. Analyzing computer-based decision support systems. Ann Intern Med. 1994 Sep 15;121(6):469–469. doi: 10.7326/0003-4819-121-6-199409150-00017. [DOI] [PubMed] [Google Scholar]
  30. McDonald C. J. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med. 1976 Dec 9;295(24):1351–1355. doi: 10.1056/NEJM197612092952405. [DOI] [PubMed] [Google Scholar]
  31. O'Connor G. T., Plume S. K., Olmstead E. M., Morton J. R., Maloney C. T., Nugent W. C., Hernandez F., Jr, Clough R., Leavitt B. J., Coffin L. H. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. JAMA. 1996 Mar 20;275(11):841–846. [PubMed] [Google Scholar]
  32. Payne S. M. Identifying and managing inappropriate hospital utilization: a policy synthesis. Health Serv Res. 1987 Dec;22(5):709–769. [PMC free article] [PubMed] [Google Scholar]
  33. Perednia D. A., Allen A. Telemedicine technology and clinical applications. JAMA. 1995 Feb 8;273(6):483–488. [PubMed] [Google Scholar]
  34. Pinciroli F., Valenza P. An inventory of computer resources for the medical application of virtual reality. Comput Biol Med. 1995 Mar;25(2):115–125. doi: 10.1016/0010-4825(95)00003-m. [DOI] [PubMed] [Google Scholar]
  35. Robie P. W., Kendrick S. B., Richards B. R. Developing a computer literacy curriculum for residents. Acad Med. 1992 Oct;67(10):645–647. doi: 10.1097/00001888-199210000-00005. [DOI] [PubMed] [Google Scholar]
  36. Rootenberg J. D. Computer-based patient records: the next generation of medicine? JAMA. 1992 Jan 1;267(1):168–169. doi: 10.1001/jama.267.1.168. [DOI] [PubMed] [Google Scholar]
  37. Satava R. M. Virtual reality and telepresence for military medicine. Comput Biol Med. 1995 Mar;25(2):229–236. doi: 10.1016/0010-4825(94)00006-c. [DOI] [PubMed] [Google Scholar]
  38. Schneider E. C., Epstein A. M. Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. N Engl J Med. 1996 Jul 25;335(4):251–256. doi: 10.1056/NEJM199607253350406. [DOI] [PubMed] [Google Scholar]
  39. Shortell S. M., Hull K. E. The new organization of the health care delivery system. Baxter Health Policy Rev. 1996;2:101–148. [PubMed] [Google Scholar]
  40. Shortell S. M., O'Brien J. L., Carman J. M., Foster R. W., Hughes E. F., Boerstler H., O'Connor E. J. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. Health Serv Res. 1995 Jun;30(2):377–401. [PMC free article] [PubMed] [Google Scholar]
  41. Skolnick A. A., Shelton W. Experts explore emerging information technologies' effects on medicine. JAMA. 1996 Mar 6;275(9):669–670. [PubMed] [Google Scholar]
  42. Solberg L. I., Kottke T. E., Brekke M. L., Calomeni C. A., Conn S. A., Davidson G. Using continuous quality improvement to increase preventive services in clinical practice--going beyond guidelines. Prev Med. 1996 May-Jun;25(3):259–267. doi: 10.1006/pmed.1996.0055. [DOI] [PubMed] [Google Scholar]
  43. Soumerai S. B., Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. JAMA. 1990 Jan 26;263(4):549–556. [PubMed] [Google Scholar]
  44. Soumerai S. B., Salem-Schatz S., Avorn J., Casteris C. S., Ross-Degnan D., Popovsky M. A. A controlled trial of educational outreach to improve blood transfusion practice. JAMA. 1993 Aug 25;270(8):961–966. [PubMed] [Google Scholar]
  45. 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]
  46. Tierney W. M., Overhage J. M., McDonald C. J., Wolinsky F. D. Medical students' and housestaff's opinions of computerized order-writing. Acad Med. 1994 May;69(5):386–389. doi: 10.1097/00001888-199405000-00013. [DOI] [PubMed] [Google Scholar]
  47. Tunis S. R., Hayward R. S., Wilson M. C., Rubin H. R., Bass E. B., Johnston M., Steinberg E. P. Internists' attitudes about clinical practice guidelines. Ann Intern Med. 1994 Jun 1;120(11):956–963. doi: 10.7326/0003-4819-120-11-199406010-00008. [DOI] [PubMed] [Google Scholar]
  48. Vining D. J., Liu K., Choplin R. H., Haponik E. F. Virtual bronchoscopy. Relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest. 1996 Feb;109(2):549–553. doi: 10.1378/chest.109.2.549. [DOI] [PubMed] [Google Scholar]
  49. Volle R. L. Standardized testing of patient management skills. A computer-based method. Clin Orthop Relat Res. 1990 Aug;(257):47–51. [PubMed] [Google Scholar]
  50. Woodward B. The computer-based patient record and confidentiality. N Engl J Med. 1995 Nov 23;333(21):1419–1422. doi: 10.1056/NEJM199511233332112. [DOI] [PubMed] [Google Scholar]
  51. Ziegler R., Fischer G., Müller W., Göbel M. Virtual reality arthroscopy training simulator. Comput Biol Med. 1995 Mar;25(2):193–203. doi: 10.1016/0010-4825(94)00038-r. [DOI] [PubMed] [Google Scholar]
  52. van der Lei J., Duisterhout J. S., Westerhof H. P., van der Does E., Cromme P. V., Boon W. M., van Bemmel J. H. The introduction of computer-based patient records in The Netherlands. Ann Intern Med. 1993 Nov 15;119(10):1036–1041. doi: 10.7326/0003-4819-119-10-199311150-00011. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES