The Use of Information Technology in Improving Medical Performance - Part II. Physician-Support Tools

Atul A. Gawande, MD, MPH, and David W. Bates, MD, MSc

In This Article

Abstract and Introduction

Increasing data from a few sites demonstrate that information technologies can improve physician decision making and clinical effectiveness. For example, computer-based physician order entry systems, automated laboratory alert systems, and artificial neural networks have demonstrated significant reductions in medical errors. In addition, Internet services to disseminate new knowledge and safety alerts to physicians more rationally and effectively are rapidly developing, and telemedicine to improve rural access to specialty services is undergoing substantial growth.

However, even technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold. Scientific evaluation of many technologies is also lacking, and the dangers of some of these technologies may be underappreciated. Research on the effects of specific technologies should be a priority. Policies should be developed to press information technology companies, such as pharmaceutical and medical device manufacturers, to recognize the importance of clinical evaluation. Research could also analyze the characteristics of effective technologies and of physicians and organizations who implement these technologies effectively.

In recent years, there has been a sudden burst of computer-based tools to improve physician decision making and clinical effectiveness. This flowering of technology will probably have the greatest near-term impact of computers in medicine, although the use of computers as physician-support tools is still not pervasive. While slow adoption prevails for reasons previously discussed in this series, there are several islands of progress, particularly in applications designed to reduce medical errors, improve access to knowledge, and allow for telemedicine. Nonetheless, new technologies are proliferating and finding their way to a growing cadre of early adopters. When we can expect the truly beneficial technologies to achieve mass adoption, however, remains unclear.