Designing An electronic patient record with multiple real time decision support modules for managing diseases

Physician compliance with clinical guidelines varies between 30% and 50% despite knowledge of and acceptance of guidelines. In an attempt to improve the use of guidelines there is increasing interest in the development of clinical decision support systems. We are interested in designing a system that is intended for interdisciplinary use in primary, secondary, and tertiary level situations. Since 1995 we have been developing an electronic oral health record containing a decision support system for caries management. As the addition of different decision support modules was contemplated, the ability to scale up the environment became important. We decided to use Authorware (Macromedia, San Francisco, CA), which is a multi-media program generator capable of generating code for PCs, Macs, and streaming interactively across the internet. Authorware uses SQL calls to an open architecture database that is essential for easy access by multiple users. Our system has modules for demographics, medical-, dental-, social-histories, head and neck physical exam, vital signs, chief complaints, caries and periodontal disease recording graphics, automatic surveillance of input data to identify risk factors for caries with automatic classification of risk level into low, medium, or high. A suggested management strategy at the systemic and local lesion level is automatically generated for the clinician. The system is currently undergoing beta testing with Delta Dental Insurance (Boston, MA) and the Veterans' Administration (Gainesville, FL).