A problem orientated information system

It has been suggested several times that care of patients with medical problems is not carried out in a consistent manner. Emergency medical care is most usually given by junior medical staff. It seems possible that their inexperience may further increase the inconsistency of care given. An information system HOISS (House Officer Information and Scheduling System) is described. It consists principally of a data-base of 80 clinical problems and a suite of programs to access the data-base. There is also a scheduling program which prints-out a worksheet of tests needed to be done that day. A review of the care of 86 patients is given. It is seen that there is considerable variation in the investigations done for a particular clinical problem. Also routine tests are not asked for and many investigations are done which cannot be justified from the patients condition. The results of five months experience with the system are presented. It is shown for the one problem considered that management was more consistent, the routine tests were done more regularly and there were less spurious tests performed.