Abstract
A computerized, interactive audit and decisionmaking system based on the HELP system is proposed for non-physician providers in ambulatory health care. Four protocols were implemented: upper respiratory-ear, nose, and throat; urinary tract infection; chronic hypertension; and chronic diabetes. Two physicians' assistants used the system for 175 patient encounters. Data entry error rates (1%) were significantly less than those of paper protocols. For the upper respiratory, ear, nose, and throat protocol, 11 percent of the encounters resulted in physician referrals with one false-negative and four false-positive decisions. False-positive antibiotic therapy decisions by assistants were safely reduced. Patient acceptance of the automated self-history was good. No alienation of the assistants was noted. Less than two minutes per patient terminal time was required by the assistants.
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