Skip to main content
SpringerLink
Log in

Clinical Decision Support Within the Regenstrief Medical Record System

  • Chapter
Clinical Decision Support Systems

Part of the book series: Health Informatics ((HI))

Abstract

In this chapter, we review a timeline of Regenstrief Medical Record System (RMRS) studies related to decision support, describe the system’s architecture, and discuss the lessons we have learned from over a quarter century of experience with clinical decision support systems (CDSS). From the beginning, the RMRS has included mechanisms for writing rules for generating reminders to physicians, based on clinical data, including laboratory results, visit diagnosis, coded medications prescribed in the clinic, and vital signs collected on encounter forms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Prokosch HU, McDonald CJ. The effect of computer reminders on the quality of care and resource use. In: Prokosch HU, Dudeck J, eds. Hospital information systems. Amsterdam: Elsevier Science Publishers B.V.; 1995:221–239.

    Google Scholar 

  2. McDonald CJ, Bhargava B, Jeris DW. A clinical information system (CIS) for ambulatory care. Proceedings of the American Federation of Information Processing Societies National Computer Conference at Anaheim, California; May 19–22, 1975.

    Google Scholar 

  3. McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976;295:1351–1355.

    Article  PubMed  CAS  Google Scholar 

  4. Cole RB, Balmer JP, Wilson TS. Surveillance of elderly hospital patients for pulmonary tuberculosis. Br Med J 1974;1:104–106.

    Article  PubMed  CAS  Google Scholar 

  5. Craven RB, Wenzel RP, Atuk N. Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975; 82:628–632.

    PubMed  CAS  Google Scholar 

  6. Jacobs S, Greenberg HB. Diagnosis and treatment of 20 tuberculous patients who entered a community hospital. Am Rev Respir Dis 1972;105:528–531.

    PubMed  CAS  Google Scholar 

  7. Greenblatt DJ, Koch-Weser J. Adverse reactions to spironolactone. A report from the Boston Collaborative Drug Surveillance Program. JAMA 1973;225: 40–43.

    Article  PubMed  CAS  Google Scholar 

  8. Shapiro S, Slone D, Lewis GP, Jick H. Fatal drug reactions among medical inpatients. JAMA 1971;216:467–472.

    Article  PubMed  CAS  Google Scholar 

  9. Caranasos GJ, Stewart RB, Cluff LE. Drug-induced illness leading to hospitalization. JAMA 1974;228:713–717.

    Article  PubMed  CAS  Google Scholar 

  10. Kelley CR, Mamlin JJ. Ambulatory medical care quality. Determination by diagnostic outcome. JAMA 1974;227:1155–1157.

    Article  PubMed  CAS  Google Scholar 

  11. McDonald CJ. Use of a computer to detect and respond to clinical events: its effect on clinician behavior. Ann Intern Med 1976;84:162–167.

    CAS  Google Scholar 

  12. McDonald CJ, Wilson GA, McCabe GP Jr. Physician response to computer reminders. JAMA 1980;244:1579–1581.

    Article  PubMed  CAS  Google Scholar 

  13. McDonald CJ. Action-oriented decisions in ambulatory medicine. Chicago: Yearbook Medical Publishers; 1981.

    Google Scholar 

  14. McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med 1984;100:130–138.

    PubMed  CAS  Google Scholar 

  15. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–130.

    Article  PubMed  CAS  Google Scholar 

  16. Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Medical Care 1986;24(8):659–666.

    Article  PubMed  CAS  Google Scholar 

  17. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med 1989;320(1):53–56.

    Article  PubMed  CAS  Google Scholar 

  18. Litzelman DK, Dittus RS, Miller ME, Tierney WM. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med 1993;8:311–317.

    PubMed  CAS  Google Scholar 

  19. Litzelman DK, Tierney WM. Physicians’ reasons for failing to comply with computerized preventive care guidelines. J Gen Intern Med 1996;11:497–499.

    PubMed  CAS  Google Scholar 

  20. McDonald CJ, Hui SL, Tierney WM. Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics. MD Comput 1992;9:304–312.

    PubMed  CAS  Google Scholar 

  21. Shapiro S. Periodic screening for breast cancer: the HIP Randomized Controlled Trial Health Insurance Plan. J Natl Cancer Inst Monogr 1997;22:27–30.

    PubMed  Google Scholar 

  22. McDonald CJ, Tierney WM. The Medical Gopher—a microcomputer system to help find, organize and decide about patient data. West J Med 1986;145(6): 823–829.

    PubMed  CAS  Google Scholar 

  23. Overhage JM, Mamlin B, Warvel J, Tierney W, McDonald CJ. A tool for provider interaction during patient care: G-CARE. Proc Annu Symp Comput Appl Med Care 1995:178–182.

    Google Scholar 

  24. Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med 1987;107:569–574.

    PubMed  CAS  Google Scholar 

  25. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med 1990;322:1499–1504.

    Article  PubMed  CAS  Google Scholar 

  26. Tierney WM, McDonald CJ, Hui SL, Martin DK. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA 1988;259:1194–1198.

    Article  PubMed  CAS  Google Scholar 

  27. Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 1993;269:379–383.

    Article  PubMed  CAS  Google Scholar 

  28. Overhage JM, Tierney WM, McDonald CJ. Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med 1996;156: 1551–1556.

    Article  PubMed  CAS  Google Scholar 

  29. Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001;345:965–970.

    Article  PubMed  CAS  Google Scholar 

  30. Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of “corollary orders” to prevent errors of omission. J Am Med Inform Assoc 1997;4:364–375.

    PubMed  CAS  Google Scholar 

  31. Dexter PR, Wolinsky FD, Gramelspacher GP, et al. Effectiveness of computer-generated reminders for increasing discussions about advance directives and completion of advance directive forms. A randomized, controlled trial. Ann Intern Med 1998;128:102–110.

    CAS  Google Scholar 

  32. Tierney WM, Overhage JM, Takesue BY, et al. Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J Am Med Inform Assoc 1995;2:316–322.

    PubMed  CAS  Google Scholar 

  33. McDonald CJ, Overhage JM, Tierney WM, Abernathy GR, Dexter PR. The promise of computerized feedback systems for diabetes care. Ann Intern Med 1996;124(1 Pt 2):170–174.

    PubMed  CAS  Google Scholar 

  34. Tierney WM, Overhage JM, McDonald CJ. Computerizing guidelines: factors for success. Proc AMIA Annu Fall Symp 1996:459–462.

    Google Scholar 

  35. Tierney WM, Overhage JM, Murray MD, et al. Effects of computerized guidelines for managing heart disease in primary care: A randomized, controlled trial. J Gen Intern Med 2003;18:967–976.

    Article  PubMed  Google Scholar 

  36. Tierney WM, Overhage JM, Murray MD, et al. Computer-based outpatient care suggestions for reactive airways disease. J Gen Intern Med 2002;17:213–214.

    Google Scholar 

  37. Murray MD, Harris LE, Overhage JM, et al. Failure of computerized treatment suggestions to improve the health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. Pharmacotherapy 2004; 24:324–337.

    Article  PubMed  Google Scholar 

  38. Kroenke K, West SL, Swindle R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA 2001;286: 2947–2955.

    Article  PubMed  CAS  Google Scholar 

  39. McDonald CJ, Tierney WM, Overhage JM, Martin DK, Wilson GA. The Regenstrief Medical Record System: 20 years of experience in hospitals, clinics, and neighborhood health centers. MD Comput 1992;9:206–217.

    PubMed  CAS  Google Scholar 

  40. McDonald CJ, Overhage JM, Tierney WM, et al. The Regenstrief Medical Record System: a quarter century experience. Int J Med Inf 1999;54:225–253.

    Article  CAS  Google Scholar 

  41. Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. J Am Med Inform Assoc 2001;8: 361–371.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Regenstrief Institute and Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University Indianapolis, IN, 46202, USA

    Burke W. Mamlin MD (Assistant Professor)

  2. Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, 46202, USA

    J. Marc Overhage MD, PhD, FACMI (Professor)

  3. Regenstrief Institute, Indianapolis, IN, 46202, USA

    J. Marc Overhage MD, PhD, FACMI (Professor) & William Tierney MD, FACMI (Research Scientist, Chancellor’s Professor, Department of Medicine and Chief)

  4. Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA

    William Tierney MD, FACMI (Research Scientist, Chancellor’s Professor, Department of Medicine and Chief)

  5. Clinical Medicine, Regenstrief Institute, Indianapolis

    Paul Dexter MD (Associate Professor)

  6. Department of Medicine, School of Medicine Indiana University, Indianapolis, IN, 46202, USA

    Paul Dexter MD (Associate Professor) & Clement J. McDonald MD, FACP, FACMI (Director, Regenstrief Institute, Regenstrief Professor of Medical Informatics and Distinguished Professor)

Authors
  1. Burke W. Mamlin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Marc Overhage MD, PhD, FACMI
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Tierney MD, FACMI
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Dexter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clement J. McDonald MD, FACP, FACMI
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Health Informatics Program Department of Health Services Administration School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Eta S. Berner EdD, FACMI, FHIMSS (Professor) (Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Mamlin, B.W., Overhage, J.M., Tierney, W., Dexter, P., McDonald, C.J. (2007). Clinical Decision Support Within the Regenstrief Medical Record System. In: Berner, E.S. (eds) Clinical Decision Support Systems. Health Informatics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-38319-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-38319-4_9

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-33914-6

  • Online ISBN: 978-0-387-38319-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation