We developed a computer-based health care interview for employees at an urban teaching hospital. The interview is part of the hospital-wide, integrated Center for Clinical Computing (CCC) system at the Beth Israel Hospital in Boston, and is available on 1500 terminals located throughout the hospital. The program emphasizes medical problems and patterns of living for which behavioral change is considered desirable. Conducted in private and with protection of confidentiality, the interview offers information about people and facilities available to help members of the hospital community seek better health. Between May 15, 1990, and May 14, 1992, a total of 1281 people completed the interview, and 84% indicated an interest in one or more of the health-related programs offered by the hospital. That these are difficult times in America was illustrated by the unhappiness reported by 43% of the participants, including 5% who indicated that life sometimes seemed not worth living. We hope they availed themselves of the opportunity offered by the interview to obtain help for their problems, and that other hospitals will do what Beth Israel Hospital is doing to promote well-being among its employees.
We have built a clinical workstation to help doctors and nurses care for patients with HIV infection. This knowledge-based medical record system provides medication alerts, reminders about primary care, and on-line information to support the care of patients with HIV infection. We are conducting a controlled clinical trial of this computer system in a single practice setting, which consists of 18 staff physicians, 13 nurses, and 113 residents, who cooperatively practice in four teams. Two teams of physicians are assigned to an intervention group and two teams to a control group. This paper reports preliminary results from the first year of study, January 15, 1992, through January 14, 1993. During this period 274 patients with HIV infection were followed by the general medical practice--130 in a control group and 144 in an intervention group. Physicians in the intervention group more rapidly and more completely followed primary care guidelines than did physicians in the control group. Patients in the intervention group had 2476 ambulatory or emergency visits (17.2 visits per patient) compared with 1882 visits (14.5 visits per patient) for the control patients (p < 0.01). There were 101 hospitalizations for 51 patients in the intervention group (an admission rate of 0.7) compared with 104 admissions for 54 patients in the control group (an admission rate of 0.8) (p = NS). There were 8 deaths in the intervention group (5.6%) compared with 13 (10%) in the control group (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
In a previous study, investigators at McMaster University compared 14 ways to search the MEDLINE database and concluded that the method that cost the least (the National Library of Medicine's ELHILL program) yielded the highest proportion of relevant articles, whereas the method that cost the most (PaperChase) yielded the least. There are serious defects in the study design that invalidate the authors' conclusions.
Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an integral part of the clinical information system. Through a study of usage patterns during a one-week period, we found that 1247 persons sent 7482 messages to 1302 different recipients. Each category of user (attending physician, house officer, nurse, etc.) sent the most e-mail to others of the same user category. Through an electronically administered questionnaire, we found that self-reported usage patterns had a high correlation (r = 0.6) with measured use. Sixty-six percent of respondents used e-mail daily or weekly, and 58% used it for issues of patient care; nearly all users found this useful for communicating about patient care issues. Ninety percent of respondents felt e-mail made their lives easier and 61% felt it had a humanizing influence on their lives. We conclude that the e-mail system is well-utilized by clinical personnel and felt to be useful in both patient care and nonpatient care situations.
OBJECTIVE: To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors and to determine donor reactions to the use of the interview.
DESIGN: A comparison of the rate of detection of HIV-related factors elicited by a computer interview with that obtained by standard American Red Cross procedures for assessment of donor suitability, including a randomized crossover trial in which the order of the two methods was reversed. Information obtained by the computer was not available to influence the use of blood components for transfusion.
SETTING: The computer interview was administered to donors at an American Red Cross blood donor center and at a mobile blood drive at a hospital.
SUBJECTS: Consecutive sample of 294 male and female blood donors 18 to 75 years of age.
MAIN OUTCOME MEASURES: Subjects' responses to the computer-based interview as well as responses to the standard Red Cross written questionnaires and face-to-face interviews were used for donor assessment.
RESULTS: The interview took an average of 8 minutes to complete. From among 272 donors who provided complete data, the computer identified 12 donors who reported either behaviors associated with a risk of HIV acquisition or symptoms compatible with the acquired immunodeficiency syndrome; none of these donors had been so identified either by routine written questionnaires or by face-to-face interviews used to screen potential blood donors. Only one of the 12 identified donors used the confidential unit exclusion procedure to prevent use of his donated unit. The rate of elicitation of HIV-related factors by the computer interview was 12 (4.4%) of 272 (95% confidence interval [CI], 2.3% to 7.6%), compared with two (0.13%) of 1536 (95% confidence upper bound, 0.28%) using the standard Red Cross procedure (P less than .0001). Tests for antibodies to HIV were negative in blood samples from all of the 272 subjects studied. The subjects enjoyed the computer interview and judged it to be more private than the standard donor assessment method. They also predicted that donors would be more honest with the computer interview than with a human interviewer.
CONCLUSIONS: Computer-based screening elicits more HIV-related factors in the health histories of blood donors than do the standard questionnaire and interviewing methods currently in use. Computer-based screening is also acceptable to blood donors.