DEVELOPMENT AND IMPLEMENTATION OF A COMPUTER-GENERATED REMINDER SYSTEM FOR DIABETES PREVENTIVE CARE

Diabetes mellitus is a chronic condition with several late complicatio ns that can be delayed or avoided through proper preventive health car e. Although practice guidelines have been established to improve the p reventive care in diabetics, dissemination of these guidelines among p hysicians and educational programs have been only moderately successfu l in changing physicians' practice patterns. Previous efforts, however , did not utilize computer-generated reminders. We developed a system of computer-generated reminders for diabetic preventive care. We compl eted an implementation of the system in the outpatient clinics of inte rnal medicine residents at our institution. This paper describes the d evelopment and implementation of this system. Our results showed that the system flagged an average of 13 items that deviated from diabetes guideline compliance, out of a possible 21 items per patient. The resi dents completed encounter forms used by the system for 37% of patients seen during a six month period. Physician users exhibited positive at titudes toward the use of guidelines which they judged improved qualit y at no additional cost of care. However, the complexity and length of the guideline encounter forms and the additional time demands proved to be significant obstacles to current routine use. Our experience wil l help to improve the system so that it is more usable and acceptable to physicians, especially in the future as health care increasingly ma kes use of electronic medical record systems.