LETTERS TO THE EDITOR Computers in Clinical Practice To the Editor:-- The issues raised in Carter's article a b o u t medical informatics t have challenged m e for s o m e time. During m y training, Lawrence Weed, MD, frequently p o i n t e d out the fallacies in m e m o r y - b a s e d medicine. I am fascinated b y the potential of c o m p u t e r s in the practice of medicine, and I utilize QMR and GRATEFULMED in m y practice. I have r e v i e w e d several programs related to pharm a c o l o g y and have c o m e to the realization that the c o m p u t e r has not yet b e e n integrated into clinical practice. Most of w h a t I see is the d e v e l o p m e n t of a very fine electronic library. To utilize it I must break from w h a t I am doing and seek the information. The information I n e e d to access rapidly in clinical practice is easily available in source books ranging from the Washington Manual to Scientific American Medicine, various texts on outpatient medicine, and, of course, the PDR. A truly integrated p h a r m a c o l o g y p r o g r a m w o u l d n e e d at least the following characteristics. It w o u l d n e e d to store the patient's p r o b l e m list, active drug list, possibly past drug list, and adverse reaction history. It w o u l d n e e d to be the source of prescriptions. As I choose the drug it w o u l d provide the o p p o r t u n i t y to r e v i e w p h a r m a c o l o g i c considerations, cost, and other drugs in the same class, as well as other drugs in the

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same therapeutic category. The p r o g r a m w o u l d automatically search for potential p r o b l e m s w i t h m y specific choice, for the particular patient. It w o u l d print an u p d a t e d m e d i c a t i o n list and patient information sheet. It w o u l d make r e c o m m e n d a tions for pertinent follow-up and side effects to w a t c h for. It w o u l d offer the o p p o r t u n i t y to obtain and download o t h e r information I request w h i l e I go back to see the patient. This reflects a tiny portion o f the utopian dream o f c o m p u t e r s in the office. W h e t h e r the t e c h n o l o g y exists to m o v e in this direction, in a cost-effective manner, is not clear. I agree w h o l e h e a r t e d l y w i t h Carter that m a n y changes need to o c c u r before w e can achieve the p r o m ise of practice-based computers. There is little d o u b t that w h e n the c o m p u t e r can be seen as a useful tool, not s i m p l y a fancier, m o r e expensive library, it will be integrated into clinical practice. Utilization o f time is a critical factor in its acceptance, and to fully m e e t its potential it must be integrated into the flow o f everyday p r a c t i c e . - - R O G E R A. RENFREW, MD, Redington Medi-

cal Association, Skowhegan, ME 04976 Reference 1. Carter JH. Medical informatics in postgraduate training: a way to improve office-based practitioner information management. J Gen Intern Med. 1991;6:349-54.

Computers in clinical practice.

LETTERS TO THE EDITOR Computers in Clinical Practice To the Editor:-- The issues raised in Carter's article a b o u t medical informatics t have chall...
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