Research in Action
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Using computers in health care can improve the quality and
effectiveness of care and reduce its cost. However, adoption of
computerized clinical information systems in health care lags
behind use of computers in most other sectors of the economy.
Through its aggressive research program, the Agency for Health
Care Policy and Research (AHCPR) is on the forefront of efforts
to increase the use of computers in health care. Several projects
funded by AHCPR that laid the foundation for using computers in
health care are being used by the private sector.
As these AHCPR-funded projects show, computers can improve
quality and cut costs in many uses.
Automated hospital information systems can help improve quality
of care because of their far-reaching capabilities. An example is
the HELP system, one of the first information systems in a
hospital to combine the use of computers for storing and
transferring information with using them for giving advice to
solve clinical problems.
- Use of the HELP integrated system showed that the risk of
infection decreased significantly when antibiotics were given in
the 2 hours before surgery at LDS Hospital in Salt Lake City.
This was the first study of how timing of prophylaxis affects
surgical wound infections in actual clinical practice.
- The HELP system detected 60 times as many adverse drug
reactions in patients as the traditional method at LDS Hospital.
The computer-detected reactions—95 percent of which were
to severe—occurred in 648 patients over 18 months.
In addition to alerting physicians to abnormal and changing
clinical values, computers can generate reminders for physicians.
For complex problems, computer workstations can integrate patient
records, research plans, and knowledge databases.
- Physicians reminded by computer were twice as likely to give
flu vaccine to patients at high risk during the winter in a
3-year trial by Indiana University investigators. Because the
high-risk patients were vaccinated, winter hospitalizations,
emergency room visits, and tests for respiratory ailments were
reduced by 10 to 30 percent.
- Computer alerts for physicians prevented serious kidney
failure and preserved kidney function in patients at Beth Israel
Hospital in Boston. When creatinine levels (indicators of kidney
function) rose in the patients, the computers alerted the
physicians, who stopped medications being given or adjusted doses
more than 21 hours sooner than when there were no alerts.
- Use of highly interactive HIV workstations for physicians at
Beth Israel Hospital resulted in a 20-percent decrease in
hospitalization of HIV patients, increased use of primary care,
and improved quality of care. From any of the 2,000 terminals at
the hospital or from home by
telephone dialup, clinicians can access the patient data base and
the HIV knowledge data base for improved patient care.
Computers and databases can be used to compare expected results
with actual results and to help physicians make decisions.
- The quality of care of intensive care units (ICUs) can be
assessed with the Acute Physiology and Chronic Health Evaluation
(APACHE), which can compare observed with expected survival
rates. Reflecting data from 17,400 ICU patients, the APACHE III
data base can be used to adjust mortality rates to account for
differences in severity of illness.
The lives of patients can be improved if they use computer
systems to obtain information, make difficult decisions, and
contact experts and support groups.
- HIV-infected persons who used CHESS (the Comprehensive Health
Enhancement Support System) reported fewer and shorter hospital
stays (and a 40-percent decrease in hospital costs) compared with
nonusers. By interacting with the home-based computer system,
users monitored their health and spotted warning signs of serious
illnesses so they could alert their doctors quickly.
When a physician orders a test by computer, it can automatically
display information that promotes cost-effective testing and
- Total costs at Wishard Memorial Hospital in Indianapolis
decreased $594 per admission (projected hospital savings: more
than $3 million) when physicians used computers to write all
inpatient orders. The workstations were linked to a comprehensive
electronic medical record system. Total charges per admission
less when workstations were used to write all inpatient orders at
the hospital; tens of
billions could be saved nationwide.
- Physicians ordered 14 percent fewer tests per outpatient
when using computer workstations at a large primary care facility
in Indianapolis. Workstations showed prior test results,
predictions of abnormal results, and test prices.
Vision for the Future
The much vaunted information superhighway is expected to improve
the quality of life for all Americans. This vision—the
National Information Infrastructure—consists of both
existing systems and technologies and others still to emerge, all
linked nationwide. Every part of the economy, including health
care, will be affected.
AHCPR strongly supports research to make this vision a reality.
A fully functioning nationwide system will allow the easy yet
protected exchange of information among doctors, nurses,
consumers, hospital departments, insurers, and researchers.
Americans will benefit both directly (from immediate access to
patient records during emergencies) and indirectly (from research
linking data from many sources).
As part of the High Performance Computing and Communications
Program, AHCPR works with other Federal agencies to provide key
computing, communications, and software technologies to meet the
demands of the 21st century. AHCPR-supported researchers are:
- Developing an entirely paperless medical record system at
Beth Israel Hospital in Boston that links computerized patient
records with different departments, physician offices, and 20
- Developing a practical common medical terminology that will
be the basis for computerized patient records, clinical decision
support, health services research, data-driven guideline
development, and electronic interchange of patient information.
The Mayo and the Kaiser Foundations are collaborating on the
project, which is cofunded by AHCPR and the National Library of
Uniform Standards and Data
For information from different databases to be compared, common
terminologies and standards and uniform identifiers are needed.
In supporting the private development of standards, decision
analyses, and access applications, AHCPR works actively with
national and international organizations that set standards.
Since 1992, AHCPR has sponsored meetings of the Healthcare
Informatics Standards Planning Panel of the American National
Standards Institute (ANSI) and its successor, ANSI's Healthcare
Informatics Standards Board. The Board is a private-sector,
nonprofit coordinator of organizations developing national and
Two new databases demonstrate the usefulness of uniform data,
allowing comparison of health care services, medical
effectiveness, and the use and cost of hospital care. Both data
bases contain patient information for typical hospital stays in a
uniform format while protecting privacy. One data base covers
inpatient care in community hospitals in 12 States; the other is
a national sample of some 900 hospitals. Part of the Healthcare
Cost and Utilization Project, these databases cover 1988-92.
Confidentiality, Privacy, and Security
Improving the quality of care through the use of computerized
medical information systems must not override the need to protect
individual rights to privacy. Strong safeguards must protect
confidentiality. Patient rights, provider rights, and other
concerns are being addressed to prevent inadvertent disclosure or
alteration of computerized medical records. For example, AHCPR
cosponsored a conference that included proposals for strict
limitations on access and heavy penalties for abuse.
AHCPR Publication No. 96-P014
Current as of January 1996