Computer Programs to Support Clinical Decision Making-Reply

Abstract

In Reply.— We agree with Dr Norman that computer-based medical information systems have the potential to improve the quality of medical care. We have also demonstrated that a computer-based ambulatory medical record system (COSTAR) can be used to provide automatic monitoring and feedback that improve physician performance to quality assurance protocols. 1 It should be pointed out, however, that systems such as DXplain have two limitations in improving the quality of care. First, DXplain serves only to remind the physician of plausible diagnoses for a given set of signs and symptoms; the physician must still exercise clinical judgment as to the correct diagnosis. Second, a user of DXplain must enter the signs and symptoms of a given patient into the computer system as a separate and duplicate act, independent of entering the information into a medical record. We believe the full potential of such systems will not be realized until