This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schriger, D. L. Articles by Cretin, S. Search for Related Content PubMed PubMed Citation Articles by Schriger, D. L. Articles by Cretin, S.

Implementation of Clinical Guidelines via a Computer Charting System

Effect on the Care of Febrile Children Less than Three Yearsof Age

University of California-Los Angeles School of Medicine, Los Angeles, California.

Corresdpondence and reprints: David Schriger, MD, MPH, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024-2924; e-mail: <schriger{at}ucla.edu>.

Received for publication: 07/14/99; accepted for publication: 11/02/99.

Objective: The authors have shown that clinical guidelines embedded in an electronic medical record improved the quality, while lowering the cost, of care for health care workers who incurred occupational exposures to body fluid. They seek to determine whether this system has similar effects on the emergency department care of young children with febrile illness.

Design: Off-on-off, interrupted time series with intent-to-treat analysis.

Setting: University hospital emergency department.

Subjects: 830 febrile children less than 3 years of age and the physicians who treated them.

Interventions: Implementation of an electronic medical record that provides real-time advice regarding the content of the history and physical examination and recommendations regarding laboratory testing, treatment, diagnosis, and disposition.

Measurements: Documentation of essential items in the medical record and after-care instructions; compliance with guidelines regarding testing, treatment, and diagnosis; charges.

Results: The computer was used in 64 percent of eligible cases. Mean percentage documentation of 21 essential history and physical examination items increased from 80 percent during the baseline period to 92 percent in the intervention phase (13 percent increase; 95 percent CI, 10-15 percent). Mean percentage documentation of ten items in the after-care instructions increased from 48 percent at baseline to 81 percent during the intervention phase (33 percent increase; 95 percent confidence interval, 28-38 percent). All documentation decreased to baseline when the computer system was removed. There were no demonstrable improvements in appropriateness of care, nor was there evidence that appropriateness worsened. Mean charges were not changed by the intervention.

Conclusion: The intervention markedly improved documentation, had little effect on the appropriateness of the process of care, and had no effect on charges. Results for the febrile child module differ from those for the module for occupational blood and body fluid exposure (a more focused and straightforward medical condition), underscoring the need for implementation methods to be tailored to specific clinical complaints.

This article has been cited by other articles:

				J. L. Schnipper, J. A. Linder, M. B. Palchuk, J. S. Einbinder, Q. Li, A. Postilnik, and B. Middleton "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 513 - 523. [Abstract] [Full Text] [PDF]

				S. Haberman, M. Rotas, K. Perlman, and J. G. Feldman Variations in Compliance With Documentation Using Computerized Obstetric Records Obstet. Gynecol., July 1, 2007; 110(1): 141 - 145. [Abstract] [Full Text] [PDF]

				B. Chaudhry, J. Wang, S. Wu, M. Maglione, W. Mojica, E. Roth, S. C. Morton, and P. G. Shekelle Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care Ann Intern Med, May 16, 2006; 144(10): 742 - 752. [Abstract] [Full Text] [PDF]

				A. D. Harris, J. C. McGregor, E. N. Perencevich, J. P. Furuno, J. Zhu, D. E. Peterson, and J. Finkelstein The Use and Interpretation of Quasi-Experimental Studies in Medical Informatics J. Am. Med. Inform. Assoc., January 1, 2006; 13(1): 16 - 23. [Abstract] [Full Text] [PDF]

				S. T. Rosenbloom, K.-W. Chiu, D. W. Byrne, D. A. Talbert, E. G. Neilson, and R. A. Miller Interventions to Regulate Ordering of Serum Magnesium Levels: Report of an Unintended Consequence of Decision Support J. Am. Med. Inform. Assoc., September 1, 2005; 12(5): 546 - 553. [Abstract] [Full Text] [PDF]

				S. T. Rosenbloom, A. J. Geissbuhler, W. D. Dupont, D. A. Giuse, D. A. Talbert, W. M. Tierney, W. D. Plummer, W. W. Stead, and R. A. Miller Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 458 - 473. [Abstract] [Full Text] [PDF]

				S. S. Lyons, T. Tripp-Reimer, B. A. Sorofman, J. E. DeWitt, B. J. BootsMiller, T. E. Vaughn, and B. N. Doebbeling VA QUERI Informatics Paper: Information Technology for Clinical Guideline Implementation: Perceptions of Multidisciplinary Stakeholders J. Am. Med. Inform. Assoc., January 1, 2005; 12(1): 64 - 71. [Abstract] [Full Text] [PDF]

				S. T. Rosenbloom, J. Grande, A. Geissbuhler, and R. A. Miller Experience in Implementing Inpatient Clinical Note Capture via a Provider Order Entry System J. Am. Med. Inform. Assoc., July 1, 2004; 11(4): 310 - 315. [Abstract] [Full Text] [PDF]

				K. B. Johnson Barriers That Impede the Adoption of Pediatric Information Technology Arch Pediatr Adolesc Med, December 1, 2001; 155(12): 1374 - 1379. [Abstract] [Full Text] [PDF]