Information Technology in the Healthcare System of the Future
A Brief History of Cybermedicine
Information Technology in the Healthcare Information Technology in the Healthcare System of the FutureSystem of the Future
A Brief History of CybermedicineA Brief History of Cybermedicine
Warner V. Slack, M.D.Division of Clinical Computing
Harvard Medical SchoolBeth Israel Deaconess Medical Center
Warner V. Slack, M.D.Warner V. Slack, M.D.Division of Clinical ComputingDivision of Clinical Computing
Harvard Medical SchoolHarvard Medical SchoolBeth Israel Deaconess Medical CenterBeth Israel Deaconess Medical Center
Harvard-MIT Division of Health Sciences and TechnologyHST.921: Information Technology in the Health Care System of the Future, Spring 2007Course Director: Steven E. Locke, MD
Cybermedicine for the ClinicianCybermedicine for the ClinicianCybermedicine for the Clinician
Clinical UseClinical UseClinical Use
Assists with requests (order entry) Assists with requests (order entry) Assists with requests (order entry)
Clinical UseClinical UseClinical Use
Assists with requests (order entry) Provides clinical information upon requestAssists with requests (order entry) Assists with requests (order entry) Provides clinical information upon requestProvides clinical information upon request
00000000 Paxton, Minnette 3/21/70 100F
1. All Labs 11. Result Over Time2. Blood Bank 12. Microbiology3. Blood Gas 13. Neurophysiology4. Cardiology 14. Online Medical Record5. Chemistry 15. Outside/Lexington Lab6. Cytogenics 16. Pharmacy7. Cytology 17. Pulmonary Function8. Demographics 18. Radiology9. Electrocardiograms 19. Clinical Pathology
10. Hematology 20. Urinalysis
0000000000000000 Paxton, Minnette 3/21/70 100FPaxton, Minnette 3/21/70 100F
1. All Labs 1. All Labs 11. Result Over Time11. Result Over Time2. Blood Bank 2. Blood Bank 12. Microbiology12. Microbiology3. Blood Gas3. Blood Gas 13. Neurophysiology13. Neurophysiology4. Cardiology4. Cardiology 14. Online Medical Record14. Online Medical Record5. Chemistry5. Chemistry 15. Outside/Lexington Lab15. Outside/Lexington Lab6. Cytogenics6. Cytogenics 16. Pharmacy16. Pharmacy7. Cytology7. Cytology 17. Pulmonary Function17. Pulmonary Function8. Demographics8. Demographics 18. Radiology18. Radiology9. Electrocardiograms 19. Clinical Pathology9. Electrocardiograms 19. Clinical Pathology
10. Hematology10. Hematology 20. Urinalysis20. Urinalysis
Clinical UseClinical UseClinical Use
Assists with requests (order entry) Provides clinical information upon requestGives support with decisions
Assists with requests (order entry) Assists with requests (order entry) Provides clinical information upon requestProvides clinical information upon requestGives support with decisionsGives support with decisions
Clinical UseClinical UseClinical Use
Gives support with decisions– Advice and consultationGives support with decisionsGives support with decisions–– Advice and consultationAdvice and consultation
Free Water Deficit or Sodium DeficitFree Water Deficit or Sodium Deficit
Free H20 Deficit = TBW Free H20 Deficit = TBW --TBW x (Desired Na/Measured Na)TBW x (Desired Na/Measured Na)NA Deficit = TBW x (Desired NA NA Deficit = TBW x (Desired NA -- Measured Na)Measured Na)
TBWTBW = WGT X [0.6 (Male) or 0.5 (Female)]= WGT X [0.6 (Male) or 0.5 (Female)]
Weight = lbs or kg Weight = lbs or kg Male or Female? Male or Female? Current Serum Na = Current Serum Na = mEqmEq/L/LDesired Na Desired Na = = mEqmEq/L/L
Free Water Deficit or Sodium DeficitFree Water Deficit or Sodium Deficit
Look at References?Look at References?
5757FemaleFemale160160140140
Free H20 Deficit = LitersFree H20 Deficit = LitersNotes:Notes:1) Correct about half of total deficit in first 24 hours1) Correct about half of total deficit in first 24 hours2) Correction rate should be 0.5 2) Correction rate should be 0.5 mEqmEq/L/hr (12 /L/hr (12 mEqmEq/day)/day)3) Recompile deficit frequently3) Recompile deficit frequently4) Add insensible fluid losses to computed values4) Add insensible fluid losses to computed values
NN
3.6
Clinical UseClinical UseClinical Use
Gives support with decisions– Advice and consultation– Bibliographic retrieval (PaperChase)
Gives support with decisionsGives support with decisions–– Advice and consultationAdvice and consultation–– Bibliographic retrieval (PaperChase)Bibliographic retrieval (PaperChase)
Clinical UseClinical UseClinical Use
Gives support with decisions– Advice and consultation– Bibliographic retrieval (PaperChase)– Searching the clinical database
Gives support with decisionsGives support with decisions–– Advice and consultationAdvice and consultation–– Bibliographic retrieval (PaperChase)Bibliographic retrieval (PaperChase)–– Searching the clinical databaseSearching the clinical database
.
C l i n Q u e r y Sat Mar 17, 2001 3:07 pm
ClinQuery covers 495,448 admissions from 1984 through 2000.
Please enter the year or range of years (e.g. 85-90) you aregoing to search.
Year(s): 1999
..
C l i n Q u e r yC l i n Q u e r y Sat Mar 17, 2001 3:07 pm Sat Mar 17, 2001 3:07 pm
ClinQuery covers 495,448 admissions from 1984 through ClinQuery covers 495,448 admissions from 1984 through 2000.2000.
Please enter the year or range of years (e.g. 85Please enter the year or range of years (e.g. 85--90) you are 90) you are going to search.going to search.
Year(s): 1999Year(s): 1999
C l i n Q u e r y Year 1999 Sat Mar 17, 2001 3:09 pm
AgeChoice Values Admissions1) <--- .9 51452) 1.0-9.9 13) 10.0-17.9 914) 18.0-19.9 2615) 20.0-29.9 27236) 30.0-39.9 56147) 40.0-49.9 34278) 50.0-59.9 36029) 60.0-64.9 1847A) 65.0-69.9 2009 B) 70.0-79.9 4278C) 80.0 ---> 3961
Choices:
C l i n Q u e r yC l i n Q u e r y Year 1999 Sat Mar 17, 2001 3:09 pm Year 1999 Sat Mar 17, 2001 3:09 pm
AgeAgeChoiceChoice ValuesValues AdmissionsAdmissions1)1) <<------ .9.9 514551452)2) 1.01.0--9.99.9 113)3) 10.010.0--17.9 17.9 91914) 18.04) 18.0--19.9 26119.9 2615) 20.05) 20.0--29.9 272329.9 27236) 30.06) 30.0--39.9 561439.9 56147) 40.07) 40.0--49.9 342749.9 34278) 50.08) 50.0--59.9 360259.9 36029) 60.09) 60.0--64.9 184764.9 1847A) 65.0A) 65.0--69.9 2009 69.9 2009 B) 70.0B) 70.0--79.9 427879.9 4278C) 80.0 C) 80.0 ------> 3961> 3961
Choices:Choices:
Clinical UseClinical UseClinical Use
Gives support with decisions– Advice and consultation– Bibliographic retrieval (PaperChase)– Searching the clinical database– Alerts and reminders
Gives support with decisionsGives support with decisions–– Advice and consultationAdvice and consultation–– Bibliographic retrieval (PaperChase)Bibliographic retrieval (PaperChase)–– Searching the clinical databaseSearching the clinical database–– Alerts and remindersAlerts and reminders
Clinical UseClinical UseClinical Use
Assists with requests (order entry) Provides clinical information upon requestGives support with decisionsAssists with communication
Assists with requests (order entry) Assists with requests (order entry) Provides clinical information upon requestProvides clinical information upon requestGives support with decisionsGives support with decisionsAssists with communicationAssists with communication
Clinical UseClinical UseClinical Use
Assists with requests (order entry) Provides clinical information upon requestGives support with decisionsAssists with communicationAssists with clinical practice
Assists with requests (order entry) Assists with requests (order entry) Provides clinical information upon requestProvides clinical information upon requestGives support with decisionsGives support with decisionsAssists with communicationAssists with communicationAssists with clinical practiceAssists with clinical practice
Clinician’s Option:
1. Admissions or Labs by Service, Firm or Team2. Adverse Drug Reaction Reporting3. Cross Coverage Options4. Incomplete Medical Records5. Personal Patient Lookup6. Resident/Medical Student Log7. View Clinician’s Hospitalized Patients8. Confidential Counseling for House Staff
ClinicianClinician’’s Option:s Option:
1. Admissions or Labs by Service, Firm or Team1. Admissions or Labs by Service, Firm or Team2. Adverse Drug Reaction Reporting2. Adverse Drug Reaction Reporting3. Cross Coverage Options3. Cross Coverage Options4. Incomplete Medical Records4. Incomplete Medical Records5. Personal Patient Lookup5. Personal Patient Lookup6. Resident/Medical Student Log6. Resident/Medical Student Log7. View Clinician7. View Clinician’’s Hospitalized Patientss Hospitalized Patients8. Confidential Counseling for House Staff8. Confidential Counseling for House Staff
.. House Staff Support and Consultation
From time to time a House Officer or Fellow may have a personal matter that motivates him or her to seek professional counseling.
Psychiatric consultation and referral that is confidential and independent of administrative reporting is readily available.
Please feel free to call or page any of the psychiatrists listed on the next screen.
Your call will remain confidential.
Choose option(s), or ‘A’ for All:
.. .. House Staff Support and ConsultationHouse Staff Support and Consultation
From time to time a House Officer or Fellow may have a personFrom time to time a House Officer or Fellow may have a personal matter that al matter that motivates him or her to seek professional counseling.motivates him or her to seek professional counseling.
Psychiatric consultation and referral that is confidential anPsychiatric consultation and referral that is confidential and independent of d independent of administrative reporting is readily available.administrative reporting is readily available.
Please feel free to call or page any of the psychiatrists lisPlease feel free to call or page any of the psychiatrists listed on the next ted on the next screen.screen.
Your call will remain confidential.Your call will remain confidential.
Choose option(s), or Choose option(s), or ‘‘AA’’ for All:for All:
Clinical UseClinical UseClinical UseAssists with requests (order entry) Provides clinical information upon requestGives support with decisionsAssists with communicationAssists with clinical practiceAssists with education
Assists with requests (order entry) Assists with requests (order entry) Provides clinical information upon requestProvides clinical information upon requestGives support with decisionsGives support with decisionsAssists with communicationAssists with communicationAssists with clinical practiceAssists with clinical practiceAssists with educationAssists with education
Instructional ProgramsLearning by DoingIn the tradition of John Dewey,
cybermedicine promotes learning in the context of caring for real patients.
Instructional ProgramsInstructional ProgramsLearning by DoingLearning by DoingIn the tradition of John Dewey, In the tradition of John Dewey,
cybermedicine promotes learning in cybermedicine promotes learning in the context of caring for real patients.the context of caring for real patients.
Evaluating CybermedicineEvaluating CybermedicineEvaluating Cybermedicine
Use of the system by voluntary usersUse of the system by voluntary usersUse of the system by voluntary users
Beth Israel Deaconess Use of Patient Lookup:Inpatients and Outpatients
Beth Israel Deaconess Use of Patient Lookup:Beth Israel Deaconess Use of Patient Lookup:Inpatients and OutpatientsInpatients and Outpatients
21,497
44,383
12,688
30,264 35,22927,707 34,614
27,023
13,229
010,00020,00030,00040,00050,00060,00070,00080,000
1984 1988 1992 1994 1998
Num
ber
of L
ooku
ps D
urin
g a
Typi
cal W
eek
Inpatient Lookups Outpatient Lookups
4,080
21,497
44,383
12,688
30,264 35,22927,707 34,614
27,023
13,229
010,00020,00030,00040,00050,00060,00070,00080,000
1984 1988 1992 1994 1998
Num
ber
of L
ooku
ps D
urin
g a
Typi
cal W
eek
Inpatient Lookups Outpatient Lookups
4,080
Inpatients Outpatients TotalAll Labs – Most Recent Results 17,018 10,044 27,062Demographics 3,277 9,420 12,697Chemistry 4,310 4,793 9,103Radiology 2,681 6,028 8,709Narrative Notes 1,163 3,893 5,056Cardiology 1,548 2,697 4,245Pathology 528 3,562 4,090Microbiology 1,990 1,001 2,991Hematology 1,014 1,786 2,800Blood Bank 743 439 1,182Pharmacy 753 282 1,035Neurophysiology 96 251 347Pulmonary Function 108 187 295Total 35,229 44,383 79,612
Inpatients Outpatients TotalAll Labs – Most Recent Results 17,018 10,044 27,062Demographics 3,277 9,420 12,697Chemistry 4,310 4,793 9,103Radiology 2,681 6,028 8,709Narrative Notes 1,163 3,893 5,056Cardiology 1,548 2,697 4,245Pathology 528 3,562 4,090Microbiology 1,990 1,001 2,991Hematology 1,014 1,786 2,800Blood Bank 743 439 1,182Pharmacy 753 282 1,035Neurophysiology 96 251 347Pulmonary Function 108 187 295Total 35,229 44,383 79,612
Use of Patient Lookup According to Type of Inquiry at Beth Israel Deaconess,
April 27-May 3, 1998
Use of Patient Lookup According to Type of Inquiry at Beth Israel Deaconess,
April 27-May 3, 1998
0 10 20 30 40 50Lookups Per User Per Week
Residents
Students
Fellows
Staff Doctors
Nurses
Others
0 10 20 30 40 50Lookups Per User Per Week
Residents
Students
Fellows
Staff Doctors
Nurses
Others
Use of Patient LookupUse of Patient Lookup
Use of the system by voluntary usersAttitude toward the systemUse of the system by voluntary usersUse of the system by voluntary usersAttitude toward the systemAttitude toward the system
Effect on WorkEffect on WorkEffect on Work
Accuracy Speed Ease Interest
Definitely worse 4 15 8 3
Probably worse 13 24 13 10
No difference 88 54 48 147Probably better 204 192 182 190
Definitely better 236 260 294 195
Total 545 545 545 545
Use of the system by voluntary usersAttitude toward the systemEducational power of the system
Use of the system by voluntary usersUse of the system by voluntary usersAttitude toward the systemAttitude toward the systemEducational power of the systemEducational power of the system
Use of the system by voluntary usersAttitude toward the systemEducational power of the system Effect of the system on quality of care
Use of the system by voluntary usersUse of the system by voluntary usersAttitude toward the systemAttitude toward the systemEducational power of the system Educational power of the system Effect of the system on quality of careEffect of the system on quality of care
Indirect EvidenceIndirect EvidenceIndirect Evidence
Indirect Evidence
Computing that offers information requested and advice on how to use it, with more ease, speed reliability, and accuracy than otherwise possible, is improving the quality of care.
Indirect EvidenceIndirect Evidence
Computing that offers information requested Computing that offers information requested and advice on how to use it, with more ease, and advice on how to use it, with more ease, speed reliability, and accuracy than otherwise speed reliability, and accuracy than otherwise possible, is improving the quality of care.possible, is improving the quality of care.
Direct EvidenceDirect EvidenceDirect Evidence
Direct Evidence
The time to act on important clinical events is significantly reduced when the physician is reminded or alerted by the computer of the need to act.
Direct EvidenceDirect Evidence
The time to act on important clinical events is The time to act on important clinical events is significantly reduced when the physician is significantly reduced when the physician is reminded or alerted by the computer of the reminded or alerted by the computer of the need to act.need to act.
Clinician Response TimeClinician Response Time
0 50 100 150 200 250 300 350 400 450 500
Intervention Control
RemindersReminders
AlertsAlerts
(days)(days)
Direct Evidence(Bates, Kuperman, Teich, et al: 1999)
Physicians at Brigham and Women’s Hospital, who now routinely use the computing system to request laboratory tests and prescribe medications…
Direct EvidenceDirect Evidence((Bates, Kuperman, Teich, et alBates, Kuperman, Teich, et al: : 19991999))
Physicians at Brigham and WomenPhysicians at Brigham and Women’’s s Hospital, who now routinely use the Hospital, who now routinely use the computing system to request laboratory computing system to request laboratory tests and prescribe medicationstests and prescribe medications……
Direct Evidence
…make significantly fewer errors.(serious errors in medications have been reduced by 55%)
Direct EvidenceDirect Evidence
……make significantly fewer errors.make significantly fewer errors.(serious errors in medications have been (serious errors in medications have been reduced by 55%)reduced by 55%)
Use of the system by voluntary usersAttitude toward the systemEducational power of the system Effect of the system on quality of careCost of the system
Use of the system by voluntary usersUse of the system by voluntary usersAttitude toward the systemAttitude toward the systemEducational power of the system Educational power of the system Effect of the system on quality of careEffect of the system on quality of careCost of the systemCost of the system
Use of the system by voluntary usersAttitude toward the systemEducational power of the system Effect of the system on quality of careCost of the systemEffect of system on hospital finances
Use of the system by voluntary usersUse of the system by voluntary usersAttitude toward the systemAttitude toward the systemEducational power of the system Educational power of the system Effect of the system on quality of careEffect of the system on quality of careCost of the systemCost of the systemEffect of system on hospital financesEffect of system on hospital finances
Time needed to collect bills in relation to use of computing programs at Beth Israel Hospital
Time needed to collect bills in relation to use of Time needed to collect bills in relation to use of computing programs at Beth Israel Hospitalcomputing programs at Beth Israel Hospital
0
10
20
30
40
50
60
70
80
TIM
E TO
CO
LLEC
T B
ILLS
(D
AYS
)
1976 1977 1978 1979 1980 1981 1982FISCAL YEAR
Registration Programs
Clinical Programs
Time needed to collect bills in relation to use of computing programs at Brigham & Women’s
Hospital
Time needed to collect bills in relation to use of Time needed to collect bills in relation to use of computing programs at Brigham & Womencomputing programs at Brigham & Women’’s s
HospitalHospital
0102030405060708090
100
TIM
E TO
CO
LLEC
T B
ILLS
(D
AYS
)
1982 1983 1984 1985 1986 1987 1988FISCAL YEAR
Registration Programs
Clinical ProgramsFinancial Programs
Cybermedicine for the ClinicianCybermedicine for the ClinicianCybermedicine for the Clinician
Cybermedicine programs such as those in
Kaiser Permanente, Univeri
Cybermedicine programs such as those inCybermedicine programs such as those in
Kaiser Permanente, Kaiser Permanente, UniveriUniveri
Cybermedicine for the ClinicianCybermedicine for the ClinicianCybermedicine for the Clinician
Cybermedicine programs such as those in theKaiser Permanente, University of Missouri, LDS,Regenstrief Institute, Columbia’s Presbyterian,Duke, and Vanderbilt, as well as BU, Tufts,MGH, Brigham and Women’s and BIDMChospitals, have proved to be highly useful inthe practice of medicine.
Cybermedicine programs such as those in theCybermedicine programs such as those in theKaiser Permanente, University of Missouri, LDS,Kaiser Permanente, University of Missouri, LDS,Regenstrief Institute, ColumbiaRegenstrief Institute, Columbia’’s Presbyterian,s Presbyterian,Duke, and Vanderbilt, as well as BU, Tufts,Duke, and Vanderbilt, as well as BU, Tufts,MGH, Brigham and WomenMGH, Brigham and Women’’s and BIDMCs and BIDMChospitals, have proved to be highly useful inhospitals, have proved to be highly useful inthe practice of medicine.the practice of medicine.
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Early experienceEarly experienceEarly experience
Fig. 6.1 The LINC (Laboratory Instrument Computer) in use in a medical interview in 1968. (Reproduced from Slack WV, Van Cura LJ. “Patient reaction to computer-based medical interviewing.” Computers and Biomedical Research 1 (1968): 527-531. Courtesy Elsevier, Inc., http://www.sciencedirect.com. Used with permission.)
Fig. 6.1Fig. 6.1 The LINC (Laboratory Instrument Computer) in use in a medicalThe LINC (Laboratory Instrument Computer) in use in a medical interview in 1968. interview in 1968. (Reproduced from Slack WV, Van Cura LJ. (Reproduced from Slack WV, Van Cura LJ. ““Patient reaction to computerPatient reaction to computer--based medical interviewing.based medical interviewing.”” Computers and Computers and Biomedical Research Biomedical Research 1 (1968): 5271 (1968): 527--531. Courtesy Elsevier, Inc., http://531. Courtesy Elsevier, Inc., http://www.sciencedirect.comwww.sciencedirect.com. Used with permission.). Used with permission.)
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Long-Standing Problems:LongLong--Standing Problems:Standing Problems:
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Long-Standing Problems:
1. Time limitations beyond the doctor’s control>incomplete histories>insufficient counseling
LongLong--Standing Problems:Standing Problems:
1.1. Time limitations beyond the doctorTime limitations beyond the doctor’’s controls control>incomplete histories>incomplete histories>insufficient counseling>insufficient counseling
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Long-Standing Problems:
1. Time limitations beyond the doctor’s control>incomplete histories>insufficient counseling
2. Handwritten record>laborious>incomplete and illegible
LongLong--Standing Problems:Standing Problems:
1.1. Time limitations beyond the doctorTime limitations beyond the doctor’’s controls control>incomplete histories>incomplete histories>insufficient counseling>insufficient counseling
2.2. Handwritten recordHandwritten record>laborious>laborious>incomplete and illegible>incomplete and illegible
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
More Recent Problems:More Recent Problems:More Recent Problems:
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
More Recent Problems:
3. Doctors are pressured by increasingly empowered patients who with good reason want and expect more personal attention
More Recent Problems:More Recent Problems:
3.3. Doctors are pressured by increasingly Doctors are pressured by increasingly empowered patients who empowered patients who with good with good reasonreason want and expect more personal want and expect more personal attention attention
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
More Recent Problems:
3. Doctors are pressured by increasingly empowered patients who with good reasonwant and expect more personal attention
4. Doctors are pressured by financially-pressured administrators, who with questionable reason schedule more and more patients in shorter and shorter intervals
More Recent Problems:More Recent Problems:
3.3. Doctors are pressured by increasingly Doctors are pressured by increasingly empowered patients who empowered patients who with good reasonwith good reasonwant and expect more personal attention want and expect more personal attention
4.4. Doctors are pressured by financiallyDoctors are pressured by financially--pressured administrators, who pressured administrators, who with with questionable reasonquestionable reason schedule more and schedule more and more patients in shorter and shorter intervalsmore patients in shorter and shorter intervals
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Patient PowerOpportunity Afforded by the ComputerFirst PatientFirst StudyShared Record
Patient PowerPatient PowerOpportunity Afforded by the ComputerOpportunity Afforded by the ComputerFirst PatientFirst PatientFirst StudyFirst StudyShared RecordShared Record
Problems
Problems Detected by
Both Physician & Computer
Problems Detected by Physician
Only
Problems Detected by Computer
Only
Urticaria 0 0 12
Allergic rhinitis 2 0 7
Asthma 4 0 2
Drug allergy 7 0 1
Slack, W.V. et al, New England Journal of Medicine, 1966
Problems
Problems Detected by
Both Physician & Computer
Problems Detected by Physician
Only
Problems Detected by Computer
Only
Urticaria 0 0 12
Allergic rhinitis 2 0 7
Asthma 4 0 2
Drug allergy 7 0 1
Slack, W.V. et al, New England Journal of Medicine, 1966
Comparison Between Physicians and Computer when Interviewing Patients About Problems with Allergies
Comparison Between Physicians and Computer when Interviewing Patients About Problems with Allergies
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Early results led to further study and efforts to enhance rapport and yield further control.
Early results led to further study and Early results led to further study and efforts to enhance rapport and yield efforts to enhance rapport and yield further control. further control.
Yielding ControlYielding ControlYielding Control
requesting permission to proceedrequesting permission to proceedrequesting permission to proceed
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrequesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient information
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting priorities
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting priorities
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting prioritiesoffering alternatives
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting prioritiesoffering alternativesoffering alternatives
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting prioritiesoffering alternativesrespecting the right to decide
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting prioritiesoffering alternativesoffering alternativesrespecting the right to deciderespecting the right to decide
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting prioritiesoffering alternativesrespecting the right to deciderespecting the right not to decide
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting prioritiesoffering alternativesoffering alternativesrespecting the right to deciderespecting the right to deciderespecting the right not to deciderespecting the right not to decide
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting prioritiesoffering alternativesrespecting the right to deciderespecting the right not to decidehelping with uncertainty
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting prioritiesoffering alternativesoffering alternativesrespecting the right to deciderespecting the right to deciderespecting the right not to deciderespecting the right not to decidehelping with uncertaintyhelping with uncertainty
Yielding ControlYielding ControlYielding Control
requesting permission to proceedproviding sufficient informationrespecting prioritiesoffering alternativesrespecting the right to deciderespecting the right not to decidehelping with uncertaintyrespecting reluctance to respond
requesting permission to proceedrequesting permission to proceedproviding sufficient informationproviding sufficient informationrespecting prioritiesrespecting prioritiesoffering alternativesoffering alternativesrespecting the right to deciderespecting the right to deciderespecting the right not to deciderespecting the right not to decidehelping with uncertaintyhelping with uncertaintyrespecting reluctance to respondrespecting reluctance to respond
Yielding ControlYielding ControlYielding Control
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
A Computer-Based Health Care Interview for Hospital PersonnelA ComputerA Computer--Based Health Care Based Health Care Interview for Hospital PersonnelInterview for Hospital Personnel
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyGeneral medical historyGeneral medical history
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyGeneral medical historyGeneral medical historyNutrition historyNutrition history
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyExercise patterns
General medical historyGeneral medical historyNutrition historyNutrition historyExercise patternsExercise patterns
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyExercise patternsHabits
General medical historyGeneral medical historyNutrition historyNutrition historyExercise patternsExercise patternsHabitsHabits
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyExercise patternsHabitsSafety
General medical historyGeneral medical historyNutrition historyNutrition historyExercise patternsExercise patternsHabitsHabitsSafetySafety
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyExercise patternsHabitsSafetyEnvironment
General medical historyGeneral medical historyNutrition historyNutrition historyExercise patternsExercise patternsHabitsHabitsSafetySafetyEnvironmentEnvironment
The Seven Health-Related Sections of the Interview
The Seven HealthThe Seven Health--Related Related Sections of the InterviewSections of the Interview
General medical historyNutrition historyExercise patternsHabitsSafetyEnvironmentStress
General medical historyGeneral medical historyNutrition historyNutrition historyExercise patternsExercise patternsHabitsHabitsSafetySafetyEnvironmentEnvironmentStressStress
StressStressStress
In the PAST MONTH have you felt sad, discouraged or hopeless?
1. Yes2. No3. Maybe4. Don’t understand5. Skip it
Answer: 1
In the PAST MONTH have you felt sad, In the PAST MONTH have you felt sad, discouraged or hopeless?discouraged or hopeless?
1.1. YesYes2. 2. NoNo3. 3. MaybeMaybe4. 4. DonDon’’t understandt understand5.5. Skip itSkip it
Answer: Answer: 11
StressStressStress
In the PAST MONTH has life sometimes seemed as if it’s not worth living?
1. Yes2. No3. Maybe4. Don’t understand5. Skip it
Answer: 1
In the PAST MONTH has life sometimes In the PAST MONTH has life sometimes seemed as if itseemed as if it’’s not worth living?s not worth living?
11. Yes. Yes2. 2. NoNo3. 3. MaybeMaybe4. 4. DonDon’’t understandt understand5. 5. Skip itSkip it
Answer: Answer: 11
StressStressStress
When life seems like it’s not worth living, it’s often helpful to speak to someone about these feelings.
<ENTER>
When life seems like itWhen life seems like it’’s not worth living, s not worth living, itit’’s often helpful to speak to someone s often helpful to speak to someone about these feelings.about these feelings.
<ENTER><ENTER>
StressStressStress
There are several places where you could call at any time to speak in confidence about these feelings.
<ENTER>
There are several places where you could There are several places where you could call at any time to speak in confidence call at any time to speak in confidence about these feelings.about these feelings.
<ENTER><ENTER>
StressStressStress
Help is available any time day or night through the:Employee Assistance Program - (617) 123-1234
Samaritans - (617) 222-3131
Or you can always contact the Emergency Room (Ext. 3337)
Please be assured that whatever you say will be kept confidential
Help is available any time day or night through the:Help is available any time day or night through the:Employee Assistance Program Employee Assistance Program -- (617) 123(617) 123--12341234
Samaritans Samaritans -- (617) 222(617) 222--31313131
Or you can always contact the Emergency Or you can always contact the Emergency Room (Ext. 3337)Room (Ext. 3337)
Please be assured that whatever you say will be kept Please be assured that whatever you say will be kept confidentialconfidential
StressStressStress
Would you like to discuss this when you visit with your employee nurse?
1. Yes2. No3. Maybe4. Don’t understand5. Skip it
Answer: 1
Would you like to discuss this when you visit Would you like to discuss this when you visit with your employee nurse?with your employee nurse?
1.1. YesYes2. No2. No3. Maybe3. Maybe4. 4. DonDon’’t understandt understand5. 5. Skip itSkip it
Answer: Answer: 11
StressStressStress
You will be receiving a printed summary of this interview at that visit.
Would it be ok to indicate on your summary that you would like to discuss this issue?
1. Yes2. No
Answer: 2
You will be receiving a printed summary of this You will be receiving a printed summary of this interview at that visit.interview at that visit.
Would it be ok to indicate on your summary that you Would it be ok to indicate on your summary that you would like to discuss this issue?would like to discuss this issue?
1. 1. YesYes2. 2. NoNo
Answer:Answer: 22
StressStressStress
That’s fine, but please feel free to talk about it at your visit.
<ENTER>
ThatThat’’s fine, but please feel free to talk s fine, but please feel free to talk about it at your visit.about it at your visit.
<ENTER><ENTER>
Sex DistributionSex Sex DistributionDistribution
Males 530Females 1407
Total 1937
MalesMales 530530FemalesFemales 14071407
TotalTotal 19371937
In the past month have you felt sad, discouraged, or hopeless?In the past month have you felt sad, In the past month have you felt sad, discouraged, or hopeless?discouraged, or hopeless?
Yes 811 (42%)No 890 (46%)Maybe 190 (10%)Don’t understand 12 (1%)Skip it 34 (2%)
YesYes 811811 (42%)(42%)NoNo 890890 (46%)(46%)MaybeMaybe 190190 (10%)(10%)DonDon’’t understandt understand 1212 (1%)(1%)Skip itSkip it 3434 (2%)(2%)
In the past month has life sometimes seemed like it’s not worth living?In the past month has life sometimes In the past month has life sometimes seemed like itseemed like it’’s not worth living?s not worth living?
Yes 106 (6%)No 812 (42%)Maybe 57 (3%)Don’t understand 3 (0%)Skip it 33 (2%)
YesYes 106106 (6%)(6%)NoNo 812812 (42%)(42%)MaybeMaybe 5757 (3%)(3%)DonDon’’t understandt understand 33 (0%)(0%)Skip itSkip it 3333 (2%)(2%)
Health-Related Program RequestsHealthHealth--Related Program RequestsRelated Program Requests
Fitness Center 1385Stress Reduction 724Time Management 457Low-Back Protection 260Smoking Cessation 126
Total 2952
Fitness CenterFitness Center 13851385Stress ReductionStress Reduction 724724Time ManagementTime Management 457457LowLow--Back ProtectionBack Protection 260260Smoking CessationSmoking Cessation 126126
TotalTotal 29522952
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Concerns about the computer as anegative, depersonalizing influencewould prove unfounded.
Concerns about the computer as aConcerns about the computer as anegative, depersonalizing influencenegative, depersonalizing influencewould prove unfounded.would prove unfounded.
PreferenceComputer vs. Doctor or Nurse
PreferencePreferenceComputer vs. Doctor or NurseComputer vs. Doctor or Nurse
12%3%39%
46%
Doctor or nurse ComputerNo preference Skip it
12%3%39%
46%
Doctor or nurse ComputerNo preference Skip it
16%6% 78%16%6% 78%
50%
42%8%50%
42%8%
Did the computer sometimes ask more than you wanted to tell?
Did the computer sometimes ask more than you wanted to tell?
Did you sometimes want totell the computer more than it asked?
Did you sometimes want totell the computer more than it asked?
YesYesYes NoNoNo UncertainUncertainUncertain
Revelation in the Absence of aFace-to-Face Encounter
Revelation in the Absence of aRevelation in the Absence of aFaceFace--toto--Face EncounterFace Encounter
Improved Alcohol ScreeningImproved Alcohol ScreeningImproved Alcohol Screening
Computer interview, but not doctor’s note 14
Doctor’s note, but not computer interview 0
Computer interview and doctor’s note 80
Computer interview, but ? doctor’s note 6
Computer interviewComputer interview, , but not doctorbut not doctor’’s note 14s note 14
DoctorDoctor’’s note, but not computer interview s note, but not computer interview 00
Computer interview and doctorComputer interview and doctor’’s note s note 8080
Computer interview, but ? doctorComputer interview, but ? doctor’’s notes note 66
Interview selfInterview self--reported vs. clinicianreported vs. clinician--documenteddocumentedalcohol use were compared for 100 initial visitsalcohol use were compared for 100 initial visits
Discrepant Case #1Discrepant Case #1Discrepant Case #1
MD’s note“uses alcohol socially”
Computer’s note“frequency 2-3/week, 3-4/day, 6+ drinks
monthly, blackouts monthly”
MDMD’’s notes note““uses alcohol uses alcohol sociallysocially””
ComputerComputer’’s notes note““frequency 2frequency 2--3/week, 33/week, 3--4/day, 6+ drinks 4/day, 6+ drinks
monthly, monthly, blackouts monthlyblackouts monthly””
Discrepant Case #2Discrepant Case #2Discrepant Case #2
MD’s note“occasional ETOH”
Computer’s note“had drinking problem in the past,
abstinent now”
MDMD’’s notes note““occasional ETOHoccasional ETOH””
ComputerComputer’’s notes note““had drinking problem in the pasthad drinking problem in the past, ,
abstinent nowabstinent now””
Revelation in the Absence of aFace-to-Face Encounter
Revelation in the Absence of aRevelation in the Absence of aFaceFace--toto--Face EncounterFace Encounter
Computer-based interview of potential blood donors elicited more HIV-related factors in the health histories than the standard questionnaire and interpersonal interviewing methods currently in use at the Red Cross.
ComputerComputer--based interview of potential blood based interview of potential blood donors elicited more HIVdonors elicited more HIV--related factors in related factors in the health histories than the standard the health histories than the standard questionnaire and interpersonal interviewing questionnaire and interpersonal interviewing methods currently in use at the Red Cross. methods currently in use at the Red Cross.
Computer-Based Screeningfor HIV Risk
ComputerComputer--BasedBased ScreeningScreeningfor HIV Riskfor HIV Risk
0
10
20
30
40
50
60
70% of Subjects
More Honest withComputer
Equally Honest More Honest withHuman Interviewer
0
10
20
30
40
50
60
70% of Subjects
More Honest withComputer
Equally Honest More Honest withHuman Interviewer
Locke SE, et al. JAMA, 1992 Locke SE, et al. JAMA, 1992
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Printed summaries developed with thepatient as well as the doctor in mind.Printed summaries developed with thePrinted summaries developed with thepatientpatient as well as the doctor in mind.as well as the doctor in mind.
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
Dialogue between patient and doctorthe mainstay of clinical medicine,but with problems
Patient-computer dialogue onepossible solution
Dialogue between patient and doctorDialogue between patient and doctorthe mainstay of clinical medicine,the mainstay of clinical medicine,but with problemsbut with problems
PatientPatient--computer dialogue onecomputer dialogue onepossible solutionpossible solution
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
The Internet as a mediator ofpatient-computer dialogueThe Internet as a mediator ofThe Internet as a mediator ofpatientpatient--computer dialoguecomputer dialogue
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
The patient as a health-care resourceThe The patientpatient as a healthas a health--care resourcecare resource
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
The Computer as a Patient’s AssistantThe Computer as a PatientThe Computer as a Patient’’s Assistants Assistant
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Urinary Tract InfectionUrinary Tract InfectionUrinary Tract Infection
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerTeaching program for use of the computerTeaching program for use of the computer
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicated
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicated
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infection
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infection
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infectionUrine culture
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infectionUrine cultureUrine culture
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infectionUrine cultureDiscussion of therapy
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infectionUrine cultureUrine cultureDiscussion of therapyDiscussion of therapy
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infectionUrine cultureDiscussion of therapyPatient’s Choice about treatment
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infectionUrine cultureUrine cultureDiscussion of therapyDiscussion of therapyPatientPatient’’s Choice about treatments Choice about treatment
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infectionUrine cultureDiscussion of therapyPatient’s Choice about treatmentTherapy
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infectionUrine cultureUrine cultureDiscussion of therapyDiscussion of therapyPatientPatient’’s Choice about treatments Choice about treatmentTherapyTherapy
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Teaching program for use of the computerGeneral medical history, conditions for referral, and referral if indicatedHistory referable to urinary tract infectionUrine cultureDiscussion of therapyPatient’s Choice about treatmentTherapyReturn Visit
Teaching program for use of the computerTeaching program for use of the computerGeneral medical history, conditions for General medical history, conditions for referral, and referral if indicatedreferral, and referral if indicatedHistory referable to urinary tract infectionHistory referable to urinary tract infectionUrine cultureUrine cultureDiscussion of therapyDiscussion of therapyPatientPatient’’s Choice about treatments Choice about treatmentTherapyTherapyReturn VisitReturn Visit
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
After mastery of the keyboard, the program offers a bit of reinforcement,e.g.“ You have a nice touch with the keys.”
After mastery of the keyboard, the program After mastery of the keyboard, the program offers a bit of reinforcement,offers a bit of reinforcement,e.g.e.g.““ You have a nice touch with the keys.You have a nice touch with the keys.””
Patient-Computer DialoguePatientPatient--ComputerComputer DialogueDialogue
If it is OK with you, we would now like to ask a few questions about urinary symptoms...
If it is OK with you, we would now If it is OK with you, we would now like to ask a few questions about like to ask a few questions about urinary symptoms...urinary symptoms...
Patient-Computer DialoguePatientPatient--ComputerComputer DialogueDialogue
Are you bothered by pain or burning when you urinate?
1.Yes2. No3. Maybe ( don’t know)4. Don’t understand5. Skip it
Are you bothered by pain or burning Are you bothered by pain or burning when you urinate?when you urinate?
1.Yes1.Yes2. No2. No3. Maybe ( don3. Maybe ( don’’t know)t know)4. Don4. Don’’t understandt understand5. Skip it5. Skip it
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Of these: 1. How well does the medicine work?2. How much does it cost?3. How safe is it?4. How often must it be taken?5. Is it a pill or an injection?6. Can I get well without it?
Which is most important to you: 1
Of these:Of these: 1. How well does the medicine work?1. How well does the medicine work?2. How much does it cost?2. How much does it cost?3. How safe is it?3. How safe is it?4. How often must it be taken?4. How often must it be taken?5. Is it a pill or an injection?5. Is it a pill or an injection?6. Can I get well without it?6. Can I get well without it?
Which is most important to you: 1Which is most important to you: 1
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Of these: 1. How well does the medicine work?2. How much does it cost?3. How safe is it?4. How often must it be taken?5. Is it a pill or an injection?6. Can I get well without it?
Which is most important to you: 1and which is least important : 5
Of these:Of these: 1. How well does the medicine work?1. How well does the medicine work?2. How much does it cost?2. How much does it cost?3. How safe is it?3. How safe is it?4. How often must it be taken?4. How often must it be taken?5. Is it a pill or an injection?5. Is it a pill or an injection?6. Can I get well without it?6. Can I get well without it?
Which is most important to you: 1Which is most important to you: 1and which is least important : 5and which is least important : 5
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
You indicated that knowing how well sulfa works is perhaps most important to you...
Let’s consider this first.
You indicated that knowing how well You indicated that knowing how well sulfa works is perhaps most sulfa works is perhaps most important to you...important to you...
LetLet’’s consider this firsts consider this first..
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Before deciding about sulfa, would you like to go over anything again?
1. Yes2. No3. Maybe ( don’t know)4. Don’t understand5. Skip it
Before deciding about sulfa, would you Before deciding about sulfa, would you like to go over anything again?like to go over anything again?
1. Yes1. Yes2. No2. No3. Maybe ( don3. Maybe ( don’’t know)t know)4. Don4. Don’’t understandt understand5. Skip it5. Skip it
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Very well then...would you like to 1. Take sulfa2. Take nothing3. Consider another medicine4. Uncertain (can’t decide)
Very well then...would you like to Very well then...would you like to 1. Take sulfa1. Take sulfa2. Take nothing2. Take nothing3. Consider another medicine3. Consider another medicine4. Uncertain (can4. Uncertain (can’’t decide)t decide)
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
It seems that you took some extra time with your answer. Does this mean that you’ve been:
1. Thinking it over and feel you’ve made the right choice?
2. Trying to get things clear butaren’t sure about your choice?
It seems that you took some extra time It seems that you took some extra time with your answer. Does this mean that with your answer. Does this mean that youyou’’ve been:ve been:
1. Thinking it over and feel you1. Thinking it over and feel you’’ve ve made the right choice?made the right choice?
2. Trying to get things clear but2. Trying to get things clear butarenaren’’t sure about your choice?t sure about your choice?
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
We hope it’s OK then, to ask again what is your decision?
1. Uncertain (can’t decide)2. Consider another medicine 3. Take nothing4. Take sulfa
We hope itWe hope it’’s OK then, to ask again what is s OK then, to ask again what is your decision?your decision?
1. Uncertain (can1. Uncertain (can’’t decide)t decide)2. Consider another medicine 2. Consider another medicine 3. Take nothing3. Take nothing4. Take sulfa4. Take sulfa
Results (46 Patients)Results Results (46 Patients)(46 Patients)
10 referred by the program for further evaluation
35 decided to take sulfisoxazole
1 decided to wait for culture, which was negative
10 referred by the program for further evaluation10 referred by the program for further evaluation
35 decided to take sulfisoxazole35 decided to take sulfisoxazole
1 decided to wait for culture, which was negative1 decided to wait for culture, which was negative
Patients’ Reaction to the ComputerPatientsPatients’’ Reaction to the ComputerReaction to the Computer
How has it been to decide for yourself about taking sulfa?
A good thing 30Better left up to someone else 1No preference either way 3Not sure 2
How has it been to decide for yourself How has it been to decide for yourself about taking sulfa?about taking sulfa?
A good thingA good thing 3030Better left up to someone elseBetter left up to someone else 11No preference either wayNo preference either way 33Not sureNot sure 22
Patients’ Reaction to the ComputerPatientsPatients’’ Reaction to the ComputerReaction to the Computer
Was the computer considerate?
Yes 34No 0Maybe 0Don’t understand 0Skip it 2
Was the computer considerate?Was the computer considerate?
YesYes 3434NoNo 00MaybeMaybe 00DonDon’’t understandt understand 00Skip itSkip it 22
Cybermedicine for the PatientCybermedicine for the PatientCybermedicine for the Patient
More research is needed.More research is needed.More research is needed.
Image removed due to copyright restrictions.Image removed due to copyright restrictions.
Cartoon about computers replacing psychotherapists.Cartoon about computers replacing psychotherapists.
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)Patient Site (a secure Web Site)Patient Site (a secure Web Site)
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)
view results of diagnostic studies
Patient Site (a secure Web Site)Patient Site (a secure Web Site)
view results of diagnostic studiesview results of diagnostic studies
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)
view results of diagnostic studiesview medications
Patient Site (a secure Web Site)Patient Site (a secure Web Site)
view results of diagnostic studiesview results of diagnostic studiesview medicationsview medications
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)
view results of diagnostic studiesview medicationsrequest prescriptions
Patient Site (a secure Web Site)Patient Site (a secure Web Site)
view results of diagnostic studiesview results of diagnostic studiesview medicationsview medicationsrequest prescriptionsrequest prescriptions
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)
view results of diagnostic studiesview medicationsrequest prescriptionsrequest appointments and referrals
Patient Site (a secure Web Site)Patient Site (a secure Web Site)
view results of diagnostic studiesview results of diagnostic studiesview medicationsview medicationsrequest prescriptionsrequest prescriptionsrequest appointments and referralsrequest appointments and referrals
Patient-Computer DialoguePatientPatient--Computer DialogueComputer Dialogue
Patient Site (a secure Web Site)
view results of diagnostic studiesview medicationsrequest prescriptionsrequest appointments and referralscommunicate with doctors & staff
Patient Site (a secure Web Site)Patient Site (a secure Web Site)
view results of diagnostic studiesview results of diagnostic studiesview medicationsview medicationsrequest prescriptionsrequest prescriptionsrequest appointments and referralsrequest appointments and referralscommunicate with doctors & staffcommunicate with doctors & staff
Cybermedicine for bothPatient and Clinician
Cybermedicine for bothCybermedicine for bothPatient and ClinicianPatient and Clinician
The ClinHaven, and a hope for the futureThe ClinHaven, and a hope for the futureThe ClinHaven, and a hope for the future
Image removed due to copyright restrictions.Image removed due to copyright restrictions.
Cartoon about stereotypically illegible doctor handwriting.Cartoon about stereotypically illegible doctor handwriting.