Improving the quality of ambulatory health care with enhanced medical information systems: using the computer to diagnose faulty clinical processes.

The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.