A RANDOMIZED CONTROLLED TRIAL OF A COMPUTER-BASED PHYSICIAN WORKSTATION IN AN OUTPATIENT SETTING - IMPLEMENTATION BARRIERS TO OUTCOME EVALUATION

Objective: A research prototype Physician Workstation (PWS) incorporat ing a graphical user interface and a drug ordering module was compared with the existing hospital information system in an academic Veterans Administration General Medical Clinic. Physicians in the intervention group received recommendations for drug substitutions to reduce costs and were alerted to potential drug interactions. The objective was to evaluate the effect of the PWS on user satisfaction, on health-relate d outcomes, and on costs. Design: A one-year, two-period, randomized c ontrolled trial with 37 subjects. Measurements: Differences in the rel iance on noncomputer sources of information, in user satisfaction, in the cost of prescribed medications, and in the rate of clinically rele vant drug interactions were assessed. Results: The study subjects logg ed onto the workstation an average of 6.53 times per provider and used it to generate 2.8% of prescriptions during the intervention period. On a five-point scale (5 = very satisfied, 1 = very dissatisfied), use r satisfaction declined in the PWS group (3.44 to 2.98 p = 0.008), and increased in the control group (3.23 to 3.72, p < 0.0001). Conclusion : The intervention physicians did not use the PWS frequently enough to influence information-seeking behavior, health outcomes, or cost. The study design did not determine whether the poor usage resulted from s atisfaction with the control system, problems using the PWS interventi on, or the functions provided by the PWS intervention. Evaluative stud ies should include provisions to improve the chance of successful impl ementation as well. as to yield maximum information if a negative stud y occurs.