Haynes RB et al. 1987 "Computer-aided quality assurance: a critical appraisal."

Haynes RB, Walker CJ. Computer-aided quality assurance: a critical appraisal. Arch Intern Med 1987;147(7):1297-1301.
"Computerized information systems hold the promise of overcoming problems in the management of clinical information. Many of the claims of the creators and promoters of these systems, however, are not based on sound clinical studies. To determine the ability of computer information systems to improve the quality of medical care, we applied methodological criteria to published articles in the field. Only 30 (22%) of 135 articles reported preplanned investigations, and only half of these met minimal criteria for scientific investigations. Fourteen studies were well designed and executed. All studies reported improvements in the process of care. However, patient outcomes were not measured, not affected, or only minimally influenced. While computer information systems show increasing potential, more work is required to enhance their effect on the quality of care and thus on patient outcomes."
"To apprise ourselves of the best evidence currently available concerning the role of computers and computer programs in improving the process and outcomes of medical care."
not applicable
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Electronic medical records (EMR)
Type of Health IT Functions
Functions were varied and included patient visit summaries, reminders for follow-up visits, and dosing calculations.
Workflow-Related Findings
"Physicians provided indicated care significantly more frequently when they were given computer reminders than when they were not so prompted."
"The computer-assisted physicians significantly increased their generic prescribing over the physicians not receiving computer feedback."
"Four of the more comprehensive studies found positive effects on physician performance that were not accompanied by improved patient outcomes, and the remaining two found limited effects on patient outcomes, emphasizing that improved quality of patient care cannot be assumed even if the process of care appears to improve."
Study Design
Systematic literature review
Study Participants
The literature search was conducted during the period from January 1982 to September 1986. The following databases and citations were searched: (1) Cumulated Index Medicus (1975 - 1979); (2) International Information Services for the Physics and Engineering Communities (INSPEC) (1977 onward); (3) Medline (1980 onward); (4) Science Citation Index; (5) citations in articles retrieved ; (6) bibliographies on diagnostic and decision support systems; and (7) citations provided by colleagues. Articles were selected if "they reported preplanned investigations of the effect of computerized information systems on the process and/or outcome of health care." Of 135 articles retrieved that met the search terms, 16 met all the authors' standards for detailed review.