EFFECTS OF A KNOWLEDGE-BASED ELECTRONIC PATIENT RECORD ON ADHERENCE TO PRACTICE GUIDELINES

In a controlled (prospective nonrandomized study of the effects of ele ctronic rules and reminders on adherence to clinical practice guidelin es, we studied 126 physicians and nurse practitioners who were caring for 349 patients with human immunodeficency virus (HIV) infection. We analyzed the response times of these clinicians to the situations that triggered electronic alerts and reminders, the number of visits to th e primary care practice, and the rates of hospitalization. The median response times to 303 alerts in the intervention group and 388 alert-g enerating situations in the control group were 11 and 52 days, respect ively (P<0.0001). The median response times to 432 reminders in the in tervention group and 360 reminder-generating situations in the control group were 114 and >500 days (P<0.0001). The number of visits to the primary care practice was unaffected. However the number of visits to providers outside the primary care practice teas increased-a result ex plained by an increase in visits to ophthalmologists. There were no di fferences in admission rates, admissions for pneumocystosis, visits to the emergency ward, or survival. We conclude that the electronic know ledge-based medical record was effective in helping clinicians adhere to practice guidelines.