Clinical information system for junior doctors

A review of diagnostic inaccuracy

A review is presented of autopsy evidence demonstrating clinical diagnostic inaccuracy. Startling results emerge: the major clinical diagnosis is not confirmed in up to 45 per cent of cases, with typical error rates of up to 30 per cent; autopsy reveals unexpected major findings in up to 33 per cent of cases; management should have been different in up to 24 per cent of cases; clinicians cannot identify which patients are likely to have errant diagnoses; clinically 'certain' diagnoses still have a high error rate. These error rates have not changed significantly since an early study in 1912 despite the current widespread use of advanced investigation modalities.

A survey of decision aids for clinicians

Inconsistency in applying medical knowledge is a major reason for varying standards of medical care. Five types of aid have been introduced into medicine to help decision-making: questionnaires, algorithms, database systems, diagnostic systems, and, finally, computer-based decision-support systems. Of these, the most effective act as reminder or prompt systems to assist doctors without threatening their clinical freedom.

Improving the consistency with which investigations are requested

The study shows how a computer-based prompt system improved the frequency with which a set of routine laboratory investigations were ordered. In the first study the number of tests not ordered fell from 68 to 16, and in a second study from 130 to 19.

House Officer Information System--HOIS

The design and operation of a clinical information system called HOIS (House Officer Information System) is described. Information about the management of 78 common acute medical problems is available to the user from this system. An analysis is presented of the medical problems found in 631 medical in-patients. It is reported that 98% of patients had at least one of the 78 problems found in HOIS's data base, and that 82% of all problems in these patients were found in this database.