How effective is the computer-based clinical practice guideline?

CONTEXT The primary prevention of coronary artery disease in patients with diabetes could have a large impact on health care costs and outcomes. Guidelines for improving diabetic health indices are common, but significant challenges exist in implementing them. GENERAL QUESTION How does integrating an evidence-based guideline into an electronic medical record affect patient care? SPECIFIC RESEARCH CHALLENGE How can we implement the new guideline-enhanced medical record in a controlled manner and measure its impact on physician satisfaction, diabetes process measures, and the risk for cardiovascular disease? PROPOSED APPROACH All patients in the University of Washington system have an electronic Web-based medical record. Patients with diabetes will be randomly assigned to a guideline-enhanced or standard electronic medical record. The electronic medical record allows measurement of most clinical process measures and outcomes. Physician satisfaction will be measured by survey. POTENTIAL DIFFICULTIES Contamination may occur when guideline recommendations are applied to control patients as physicians gain experience with the guideline-enhanced record.