Introducing hypertext in primary health care: a study on the feasibility of decision support for practitioners

A study on the feasibility of the introduction of hypertext systems for communication of medical knowledge in primary care is described. Shortliffe's constraints on areas for application of decision support are evaluated (i.e., theoretical barriers, observable and recognized needs among users, sources of usable knowledge, available system development method). Considering the barriers derived from the knowledge types and forms used by practitioners, hypertext was found suitable as support at 'breakdowns' in practice routines, to generate 'alarms', as well as for continued medical education. A survey of the a priori acceptance of decision support systems by general practitioners showed that 84% would use the computer support if it was available today and that full-text databases, such as hypertext, were given highest priority for introduction. Local specialist physicians were identified as knowledge sources for therapy advice. Implementation of prototype systems envisioned use of hypertext in primary care as the introduction of a communication medium for co-operative health care decision making. A model for the introduction into the work environment is described.