Abstract
In our study we were interested in the value of computer-based patient histories for decision making. Ninety-nine patients from the outpatient clinic of Medicine answered a computer-driven interview, resulting in a computer-based patient record (PR). These patients also participated in an oral interview, resulting in the standard written medical record (MR). The results of the latter interview were later transcribed to a computerized format (TR).
For all 99 patients, the PR, MR and TR were compared regarding patient complaints, diagnostic hypotheses, and interobserver, intraobserver, interrecord, and intrarecord variation. All records were also compared with the final diagnosis. The PR contained about 40% more data items than the MR. Three internists each interpreted 72 records. The number of diagnostic hypotheses that the internists postulated on the basis of the PR was about 20% higher than those stated on the basis of the MR. On average, 3.3 diagnostic hypotheses were formulated per record. Intraobserver agreement was 51%, and was independent of the type of record. Interobserver agreement was less: 32%. The interrecord agreement varied from 25% (between MR and PR) to 35% (between TR and PR). The agreement between the final diagnosis and the MR data was significantly higher (33%) than between the final diagnosis and the PR data (22%). Interobserver agreement for the final diagnosis itself was 35%.
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Selected References
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- Coombs G. J., Murray W. R., Krahn D. W. Automated medical histories: factors determining patient performance. Comput Biomed Res. 1970 Apr;3(2):178–181. doi: 10.1016/0010-4809(70)90024-8. [DOI] [PubMed] [Google Scholar]
- Grossman J. H., Barnet G. O., McGuire M. T., Swedlow D. B. Evaluation of computer-acquired patient histories. JAMA. 1971 Feb 22;215(8):1286–1291. [PubMed] [Google Scholar]
- Logie A. R., Madirazza J. A., Webster I. W. Patient evaluation of a computerised questionnaire. Comput Biomed Res. 1976 Apr;9(2):169–176. doi: 10.1016/0010-4809(76)90040-9. [DOI] [PubMed] [Google Scholar]
- Lucas R. W., Card W. I., Knill-Jones R. P., Watkinson G., Crean G. P. Computer interrogation of patients. Br Med J. 1976 Sep 11;2(6036):623–625. doi: 10.1136/bmj.2.6036.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mellner C., Selander H., Wolodarski J. The computerized problem-oriented medical record at Karolinska Hospital -- format and function, users' acceptance and patient attitude to questionnaire --. Methods Inf Med. 1976 Jan;15(1):11–20. [PubMed] [Google Scholar]
- Quaak M. J., Westerman R. F., Schouten J. A., Hasman A., van Bemmel J. H. Appraisal of computerized medical histories: comparisons between computerized and conventional records. Comput Biomed Res. 1986 Dec;19(6):551–564. doi: 10.1016/0010-4809(86)90029-7. [DOI] [PubMed] [Google Scholar]
- Quaak M. J., Westerman R. F., Schouten J. A., Hasman A., van Bemmel J. H. Computerization of the patient history--patient answers compared with medical records. Methods Inf Med. 1986 Oct;25(4):222–228. [PubMed] [Google Scholar]
- Quaak M. J., Westerman R. F., van Bemmel J. H. Comparisons between written and computerised patient histories. Br Med J (Clin Res Ed) 1987 Jul 18;295(6591):184–190. doi: 10.1136/bmj.295.6591.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Quaak M. J., van der Voort P. J., van Bemmel J. H. AIDA for the automation of the patient history. Comput Methods Programs Biomed. 1987 Nov-Dec;25(3):297–304. doi: 10.1016/0169-2607(87)90087-3. [DOI] [PubMed] [Google Scholar]
- Slack W. V., Slack C. W. Patient-computer dialogue. N Engl J Med. 1972 Jun 15;286(24):1304–1309. doi: 10.1056/NEJM197206152862408. [DOI] [PubMed] [Google Scholar]
- Trell E. Interactive computer program for self-distributed medical questionnaires: notes on technical implementation and use. Med Inform (Lond) 1983 Apr-Jun;8(2):139–143. [PubMed] [Google Scholar]