A test ordering system with automated reminders for primary care based on practice guidelines

In this article we describe a real-time automated reminder system that has been developed to change Family Physicians' (FP) test ordering behavior. Th e system focuses on the appropriateness of test requests. We aim at using t he system as a substitute for written feedback by human experts. The remind er system consists of a knowledge base, an order entry system and modules t o provide passive and active support in the form of reminders to FPs. The s ystem generates critical comments about the rationality of the test request s at the moment the FP orders a test that is not in line with national or r egional guidelines. For the first validation of the knowledge base we compa red the comments of a human expert to the comments of the reminder system o n three random samples of test requests. The overall agreement in the subse quent validation rounds was 46, 60 and 69%. The corrections made in the kno wledge base after each validation round resulted in a reminder system with 149 reminders concerning Various medical problems. Due to the corrections i n the knowledge base the reminder system reacts better over the subsequent validation rounds. (C) 2000 Elsevier Science Ireland Ltd. All rights reserv ed.