Implementation of clinical guidelines through an electronic medical record: physician usage, satisfaction and assessment

Context: We developed and evaluated the Emergency Department Expert Chartin g System (EDECS) to provide real-time guidance regarding the care of low ba ck pain in adults, fever in children, and occupational exposure to blood an d body fluids in health care workers, by embedding clinical guidelines with in an electronic medical record. Objective: To describe the behaviors and a ttitudes of physicians who used EDECS. Design: Pre-post questionnaires were used to assess physician attitudes. Time studies of the intervention phase were observational, using clocks embedded in the software. Participants: O ne hundred and forty two residents and interns in emergency, pediatric, int ernal, and family medicine and patients with the above-mentioned complaints . Main outcome measures: Physician utilization of EDECS, time spent using E DECS, physician satisfaction and beliefs. Results: Eighty four percent of t he 142 eligible physicians used EDECS at least once. Five hundred and ninet y one of 789 (75%) eligible cases were completed using EDECS. Median sessio n time decreased from 12 min for session 1, to 5.5 min for sessions 16 and above. Physicians generally agreed that care with EDECS was better than sta ndard care, particularly with respect to documentation. There was, however, considerable heterogeneity in belief among complaints. Conclusions: These data illuminate both the potentials of computer-assisted decision making an d the need for context-specific approaches when attempting to implement gui delines. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.