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JAMA. 1998;280:1291.

Computers in Medicine Theme Issue
Edited by Margaret A. Winker, MD, and William M. Silberg

Computerized Systems in Clinical Care
Several studies in this issue demonstrate the powerful integrative capacity of computer-based systems.
Bates and colleagues (SEE ARTICLE) created an electronic physician order entry system that was associated with a 55% reduction in the rate of actual and potential adverse drug events.
Raschke and colleagues (SEE ARTICLE) evaluated a computer alert system that generated more than 1000 alerts during a 6-month study; orders were revised for 53% of the alerts.
McDonald and colleagues (SEE ARTICLE) describe the technology available to create a unified electronic medical record system on the World Wide Web that provides coordinated access to regularly updated patient information, diagnostic images, and the medical literature.
Hunt and colleagues (SEE ARTICLE) in a review of trials on the effectiveness of computer-based clinical decision support systems, observe that these systems have been associated with improvements in some aspects of physician performance, but few studies have assessed the effect on patient outcomes. In an editorial, Classen (SEE ARTICLE) emphasizes the need for physician involvement in developing and assessing computer-based clinical decision support systems.

Doctoring Online
E-mail provides new opportunities for patient-physician communication but also raises new issues.
Borowitz and Wyatt (SEE ARTICLE) report that consultation requests received via an online form posted on their pediatric gastroenterology Web page required, on average, 4 minutes each for a response; most requests were submitted by patients' parents.
Eysenbach and Diepgen (SEE ARTICLE) found that only half of the physicians or Web masters from 58 dermatology Web sites responded to an unsolicited e-mail message from a fictitious patient presenting an urgent medical problem; some responses were seriously delayed. In related articles, Spielberg (SEE ARTICLE) discusses legal and ethical issues related to patient-physician e-mail communication and Ferguson (SEE ARTICLE) considers how online physician services may complement traditional health care encounters.

Using Computerized Resources in Clinical Practice
Is computerized medical information useful for obtaining evidence to support clinical decision-making during the clinical encounter?
Sackett and Straus (SEE ARTICLE) report that evidence from the medical literature was identified and applied during clinical teaching rounds using computerized and print resources on a readily available evidence cart, but fewer searches for evidence to answer clinical questions were performed after the cart was removed.
Hersh and Hickam (SEE ARTICLE) in a systematic review of studies that evaluated information retrieval systems, found that the use of current systems in patient care settings is limited, the recovery of relevant information is incomplete, and little is known about the impact of these systems on physician behavior and patient outcomes. In an editorial, Hubbs and colleagues (SEE ARTICLE) argue that ready access to online medical information must be accompanied by an increased willingness by physicians to seek information when they need it.

The Cover
"Although the message is sometimes ambiguous and unreliable, pleasure can be had in the hunt for the meaning." Richard Diebenkorn, Berkeley No. 8, 1954, American.

(SEE ARTICLE)

A Piece of My Mind
"How might the world work when most patients and most physicians are online?" From "The X Factor."

(SEE ARTICLE)

Medical News & Perspectives
Telecommunications technology enables physicians in out-of-the-way places to link with their colleagues anywhere around the globe.

(SEE ARTICLE)

Contempo 1998
The development of computerized medical information systems is outpacing public policy.

(SEE ARTICLE)

JAMA NetSight
Tips for physicians who want to create their own Web site.

(SEE ARTICLE)

Policy Perspectives
Eng and colleagues call for universal access to communication and information technologies.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Finding health information on the Internet.

(SEE ARTICLE)

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