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1.  Healthcare information technology and economics 
At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit. We review the current state of healthcare costs, federal health IT stimulus programs, and experiences of several leading organizations, and offer a model for how health IT fits into our health economic future.
PMCID: PMC3638175  PMID: 22781191
Electronic Health Records/economics Health care Reform/trends*; cost-benefit analysis; information Systems/economics*; medical records systems; Computerized/economics; Developing/using computerized provider order entry; Natural-language processing; systems to support and improve diagnostic accuracy; other specific EHR applications (results review); patient safety; decision support; data exchange; system implementation and management issues; improving the education and skills training of health professionals; Developing/using clinical decision support (other than diagnostic) and guideline systems; Measuring/improving patient safety and reducing medical errors; clinical research informatics; information Retrieval; Collaborative technologies; methods for integration of information from disparate sources; Demonstrating return on IT investment; distributed systems; distributed systems
2.  Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA 
In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.
PMCID: PMC3715367  PMID: 23355463
Usability; Human Factors; Medical Error; Health Information Technology; Electronic Health Records; Clinical Informatics
3.  Active Assistance Technology for Health-Related Behavior Change: An Interdisciplinary Review 
Information technology can help individuals to change their health behaviors. This is due to its potential for dynamic and unbiased information processing enabling users to monitor their own progress and be informed about risks and opportunities specific to evolving contexts and motivations. However, in many behavior change interventions, information technology is underused by treating it as a passive medium focused on efficient transmission of information and a positive user experience.
To conduct an interdisciplinary literature review to determine the extent to which the active technological capabilities of dynamic and adaptive information processing are being applied in behavior change interventions and to identify their role in these interventions.
We defined key categories of active technology such as semantic information processing, pattern recognition, and adaptation. We conducted the literature search using keywords derived from the categories and included studies that indicated a significant role for an active technology in health-related behavior change. In the data extraction, we looked specifically for the following technology roles: (1) dynamic adaptive tailoring of messages depending on context, (2) interactive education, (3) support for client self-monitoring of behavior change progress, and (4) novel ways in which interventions are grounded in behavior change theories using active technology.
The search returned 228 potentially relevant articles, of which 41 satisfied the inclusion criteria. We found that significant research was focused on dialog systems, embodied conversational agents, and activity recognition. The most covered health topic was physical activity. The majority of the studies were early-stage research. Only 6 were randomized controlled trials, of which 4 were positive for behavior change and 5 were positive for acceptability. Empathy and relational behavior were significant research themes in dialog systems for behavior change, with many pilot studies showing a preference for those features. We found few studies that focused on interactive education (3 studies) and self-monitoring (2 studies). Some recent research is emerging in dynamic tailoring (15 studies) and theoretically grounded ontologies for automated semantic processing (4 studies).
The potential capabilities and risks of active assistance technologies are not being fully explored in most current behavior change research. Designers of health behavior interventions need to consider the relevant informatics methods and algorithms more fully. There is also a need to analyze the possibilities that can result from interaction between different technology components. This requires deep interdisciplinary collaboration, for example, between health psychology, computer science, health informatics, cognitive science, and educational methodology.
PMCID: PMC3415065  PMID: 22698679
Behavior change; consumer health informatics; health communication; health promotion; personalization
4.  National-scale clinical information exchange in the United Kingdom: lessons for the United States 
Over the last four decades, the UK has made large investments in healthcare information technology. The authors conducted interviews and reviewed published and unpublished documents to describe national-scale clinical information exchange in England, how it was achieved, and the problems experienced that the USA might avoid. Clinical information exchange in the UK was accomplished by establishing a foundation of policy, infrastructure, and systems of care, by creating and acquiring clinical computing applications and with strong use of financial and clinical incentives. Many software and hardware vendors played a part in this effort; they participated in a national framework created by the NHS in which standards for exchange are specified and their applications designed to make clinical information exchange part of normal practice. Great potential exists for cost reduction, increased safety, and greater patient involvement as a result of clinical information exchange.
PMCID: PMC3005869  PMID: 21134976
5.  Managing the Life Cycle of Electronic Clinical Documents 
To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation.
We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators.
Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion.
Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.
PMCID: PMC1513669  PMID: 16622169
6.  Preparation and Use of Preconstructed Orders, Order Sets, and Order Menus in a Computerized Provider Order Entry System 
Objective: To describe the configuration and use of the computerized provider order entry (CPOE) system used for inpatient and outpatient care at the authors' facility.
Design: Description of order configuration entities, use patterns, and configuration changes in a production CPOE system.
Measurements: The authors extracted and analyzed the content of order configuration entities (order dialogs, preconfigured [quick] orders, order sets, and order menus) and determined the number of orders entered in their production order entry system over the previous three years. The authors measured use of these order configuration entities over a six-month period. They repeated the extract two years later to measure changes in these entities.
Results: CPOE system configuration, conducted before and after first production use, consisted of preparing 667 order dialogs, 5,982 preconfigured (quick) orders, and 513 order sets organized in 703 order menus for particular contexts, such as admission for a particular diagnosis. Fifty percent of the order dialogs, 57% of the quick orders, and 13% of the order sets were used within a six-month period. Over the subsequent two years, the volume of order configuration entities increased by 26%.
Conclusions: These order configuration steps were time-consuming, but the authors believe they were important to increase the ordering speed and acceptability of the order entry software. Lessons learned in the process of configuring the CPOE ordering system are given. Better understanding of ordering patterns may make order configuration more efficient because many of the order configuration entities that were created were not used by clinicians.
PMCID: PMC181982  PMID: 12668686
7.  Best Practices in Clinical Decision Support: the Case of Preventive Care Reminders 
Applied clinical informatics  2010;1(3):331-345.
Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges.
To identify best practices for CDS, using the domain of preventive care reminders as an example.
We assembled a panel of experts in CDS and held a series of facilitated online and in-person discussions. We analyzed the results of these discussions using a grounded theory method to elicit themes and best practices.
Eight best practice themes were identified as important: deliver CDS in the most appropriate ways, develop effective governance structures, consider use of incentives, be aware of workflow, keep content current, monitor and evaluate impact, maintain high quality data, and consider sharing content. Keys themes within each of these areas were also described.
Successful implementation of CDS requires consideration of both technical and socio-technical factors. The themes identified in this study provide guidance on crucial factors that need consideration when CDS is implemented across healthcare settings. These best practice themes may be useful for developers, implementers, and users of decision support.
PMCID: PMC3189503  PMID: 21991299
Decision Support Systems, Clinical; Clinical Governance; Medical Record Systems, Computerized; Hospital Information Systems
8.  Best Practices in Clinical Decision Support 
Applied Clinical Informatics  2010;1(3):331-345.
Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges.
To identify best practices for CDS, using the domain of preventive care reminders as an example.
We assembled a panel of experts in CDS and held a series of facilitated online and inperson discussions. We analyzed the results of these discussions using a grounded theory method to elicit themes and best practices.
Eight best practice themes were identified as important: deliver CDS in the most appropriate ways, develop effective governance structures, consider use of incentives, be aware of workflow, keep content current, monitor and evaluate impact, maintain high quality data, and consider sharing content. Keys themes within each of these areas were also described.
Successful implementation of CDS requires consideration of both technical and socio-technical factors. The themes identified in this study provide guidance on crucial factors that need consideration when CDS is implemented across healthcare settings. These best practice themes may be useful for developers, implementers, and users of decision support.
PMCID: PMC3189503  PMID: 21991299
Clinical decision support systems; clinical governance; computerized medical record systems; hospital information systems
10.  Transition from paper to electronic inpatient physician notes 
UW Medicine teaching hospitals have seen a move from paper to electronic physician inpatient notes, after improving the availability of workstations, and wireless laptops and the technical infrastructure supporting the electronic medical record (EMR). The primary driver for the transition was to unify the medical record for all disciplines in one location. The main barrier faced was the time required to enter notes, which was addressed with data-rich templates tailored to rounding workflow, simplified login and other measures. After a 2-year transition, nearly all physician notes for hospitalized patients are now entered electronically, approximately 1500 physician notes per day. Remaining challenges include time for note entry, and the perception that notes may be more difficult to understand and to find within the EMR. In general, the transition from paper to electronic notes has been regarded as valuable to patient care and hospital operations.
PMCID: PMC2995621  PMID: 20064811
11.  Automatic Identification of Critical Follow-Up Recommendation Sentences in Radiology Reports 
AMIA Annual Symposium Proceedings  2011;2011:1593-1602.
Communication of follow-up recommendations when abnormalities are identified on imaging studies is prone to error. When recommendations are not systematically identified and promptly communicated to referrers, poor patient outcomes can result. Using information technology can improve communication and improve patient safety. In this paper, we describe a text processing approach that uses natural language processing (NLP) and supervised text classification methods to automatically identify critical recommendation sentences in radiology reports. To increase the classification performance we enhanced the simple unigram token representation approach with lexical, semantic, knowledge-base, and structural features. We tested different combinations of those features with the Maximum Entropy (MaxEnt) classification algorithm. Classifiers were trained and tested with a gold standard corpus annotated by a domain expert. We applied 5-fold cross validation and our best performing classifier achieved 95.60% precision, 79.82% recall, 87.0% F-score, and 99.59% classification accuracy in identifying the critical recommendation sentences in radiology reports.
PMCID: PMC3243284  PMID: 22195225
12.  Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment 
The United States (US) Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE) systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system) in the ambulatory setting.
Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17) and staff (n = 53) perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory). Two coders independently coded to theoretical saturation and resolved discrepancies through discussions.
Ten themes emerged that describe perceptions of e-prescribing implementation: 1) improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2) improved documentation resulted in safer care; 3) efficiencies were gained by using fewer paper charts; 4) organizational support facilitated adoption; 5) transition required time; resulted in workload shift to staff; 6) hardware configurations and network stability were important in facilitating workflow; 7) e-prescribing was time-neutral or time-saving; 8) changes in patient interactions enhanced patient care but required education; 9) pharmacy communications were enhanced but required education; 10) positive attitudes facilitated adoption.
Prescribers and staff worked through the transition to successfully adopt e-prescribing, and noted the benefits. Overall impressions were favorable. No one wished to return to paper-based prescribing.
PMCID: PMC2996338  PMID: 21087524
13.  The Physical Attractiveness of Electronic Physician Notes 
Though notes in electronic medical record systems (EMRs) have advantages, they are often criticized for their unattractive and unprofessional appearance. We sought to identify notes regarded by physicians as attractive and unattractive and the characteristics of both. We sent a sample of 10 notes representing a variety of common note types to a sample of 70 physicians who are either leaders in UW Medicine or randomly selected note authors and asked them to rank the notes by their physical attractivness. We found their rankings were not random, and notes clustered into those considered most, intermediate, and least attractive. Characteristics of each group are presented. We’ll use these results to format EMR notes in a more attractive form—a goal important to our physicians—while preserving important clinical, quality and compliance features that were our original goals in moving to electronic notes.
PMCID: PMC3041462  PMID: 21347053
14.  Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System 
To measure critical order check override rates in VA Puget Sound Health Care System's computerized practitioner order entry (CPOE) system and to compare 2006 results to a similar 2001 study.
Analysis of ordering and order check data gathered by a post-hoc logging program. Use of Pearson's chi-square contingency table test comparing results from this study and the earlier study.
Factors measured were total number of orders, frequency of order check types, frequency of order check overrides by order check type and comparisons of these results with previous results.
A total of 37,040 orders generated 908 (2.5%) critical order checks. Drug-drug critical alert override rate was 74/85 (87%) in 2006 compared to 95/108 (88%) in 2001 (X 2=0.04, df=1, p=0.85). The drug-allergy override rate was 341/420 (81%) compared to 72/105 (69%) in 2001 (X 2=7.97, df=1, p=0.005). In 2001, 0.25% (105/42,621) orders generated a drug-allergy order check compared to 1.13% (420/37,040) in 2006 (X 2=238.45, df=1, p<0.0001).
Override rates of critical drug-drug and drug-allergy order checks remain high at VA Puget Sound Health Care System including significant increases in drug-allergy order checks. We recommend that monitoring override rates be regular practice in clinical computing systems and conclude that qualitative research should be carried out to better understand how physicians interact with decision support at the point of ordering.
PMCID: PMC2528033  PMID: 18579840
15.  Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review 
While medications can improve patients’ health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs.
To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals.
Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug–drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug–disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.
PMCID: PMC2215064  PMID: 17068355
16.  Viewpoint: Controversies Surrounding Use of Order Sets for Clinical Decision Support in Computerized Provider Order Entry 
Order sets provide straightforward clinical decision support within computerized provider order entry systems. They make “the right thing” easier to do because they are much faster than writing single orders; they deliver real-time, evidence-based prompts; they are easy to update; and they support coverage of multiple patient problems through linkages among order sets. This viewpoint paper discusses controversies surrounding use of order sets—advantages and pitfalls, decision-making criteria, and organizational considerations, including suggestions for vendors. Order sets have the potential to improve clinician efficiency, provide real-time guidance, facilitate compliance with Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicare & Medicaid Services performance measure sets, and encourage overall acceptance of computerized provider order entry, but may not do so unless these controversies are addressed.
PMCID: PMC2215063  PMID: 17068352
17.  The Transition to Electronic Documentation on a Teaching Hospital Medical Service 
The transition to electronic medical records (EMRs) often includes the transition from paper to electronic documentation, a topic less well described in the literature than other aspects of EMR adoption. As part of a broader EMR project, we have participated in the transition to electronic notes on the Medicine service of a teaching hospital affiliated with the University of Washington. During a one year period beginning in February 2005 we adopted the use of semi-structured documentation templates permitting both encoded and narrative text components for admission, progress, and procedure notes, and for some discharge summaries. Currently over 1400 notes are entered each week. Fifty eight percent are entered by residents, 20% by attending physicians, and the remainder by other trainees and staff. The period of greatest change from paper to electronic notes occurred (by design) during the late spring and summer. Leadership, application functionality, speed, note writing time requirements, data availability, training needs, and other factors influenced adoption of this important part of our EMR.
PMCID: PMC1839294  PMID: 17238417
18.  Evolution and use of a note classification scheme in an electronic medical record 
Titles of clinical notes within an electronic medical record (EMR) are important because they influence the speed and completeness of the review of a patient’s health record. We created a note classification scheme our EMR consisting of a 2 level hierarchy of note titles used to identify newly created and existing text and scanned notes. In a sample of 3 of the 18 months since beginning production use, an average of 2,810 notes are added each day. The number of distinct note titles rose by 32 percent between November 2003 and February 2005. Few changes were made to the upper level of the hierarchy. Thirty-three note titles accounted for 75% of the notes entered in February 2005. Note titles are one of several attributes that in conjunction with the user interface used to display them may affect the efficiency and completeness with which clinicians review their patient’s records.
PMCID: PMC1560646  PMID: 16779110
19.  Approach for Analysis of Order Check Overrides in a Computerized Practitioner Order Entry System 
While it has been established that computer practitioner order entry systems can prevent transcription errors and check orders for severe drug allergies and interactions[1], continuous monitoring of the effectiveness of order checks is important. The goal of this study is to examine the rate at which high severity order checks generated in the computer practitioner order entry system at VA Puget Sound are overridden by clinicians. We compare our results to those of a previous study[2] that found high override rates for Critical Drug Interaction and Allergy-Drug Interaction order check categories. We are interested in determining whether system changes addressing these high rates have been successful in reducing the overall override rate in these categories. Because the method used previously to extract orders is no longer available, the first step in our study was to develop a new procedure to gather order entry data. This procedure is the subject of our report.
PMCID: PMC1560465  PMID: 16779320
20.  A Cross-site Qualitative Study of Physician Order Entry 
Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals.
Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data.
Measurements: Patterns and themes concerning perceptions of POE were identified.
Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions.
Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied.
PMCID: PMC150372  PMID: 12595408
21.  Creating a note classification scheme for a multi-institutional electronic medical record 
How notes are categorized in an electronic medical record (EMR) influences how rapidly users can locate documents and enter new ones, whether algorithmic search for chart deficiencies is possible, and the ease of incorporating collections of existing notes. We balanced these competing needs when developing a note classification scheme for the Online Record of Clinical Activity (ORCA) electronic medical record at the University of Washington.
PMCID: PMC1480190  PMID: 14728472
22.  Evaluation of a Command-line Parser-based Order Entry Pathway for the Department of Veterans Affairs Electronic Patient Record 
Objective: To improve and simplify electronic order entry in an existing electronic patient record, the authors developed an alternative system for entering orders, which is based on a command- interface using robust and simple natural-language techniques.
Design: The authors conducted a randomized evaluation of the new entry pathway, measuring time to complete a standard set of orders, and users' satisfaction measured by questionnaire. A group of 16 physician volunteers from the staff of the Department of Veterans Affairs Puget Sound Health Care System–Seattle Division participated in the evaluation.
Results: Thirteen of the 16 physicians (81%) were able to enter medical orders more quickly using the natural-language–based entry system than the standard graphical user interface that uses menus and dialogs (mean time spared, 16.06 ± 4.52 minutes; P=0.029). Compared with the graphical user interface, the command-–based pathway was perceived as easier to learn (P<0.01), was considered easier to use and faster (P<0.01), and was rated better overall (P<0.05).
Conclusion: Physicians found the command- interface easier to learn and faster to use than the usual menu-driven system. The major advantage of the system is that it combines an intuitive graphical user interface with the power and speed of a natural-language analyzer.
PMCID: PMC131046  PMID: 11522769
23.  Characteristics and override rates of order checks in a practitioner order entry system. 
Order checks are important error prevention tools when used in conjunction with practitioner order entry systems. We studied characteristics of order checks generated in a sample of consecutively entered orders during a 4 week period in an electronic medical record at VA Puget Sound. We found that in the 42,641 orders where an order check could potentially be generated, 11% generated at least one order check and many generated more than one order check. The rates at which the ordering practitioner overrode 'Critical drug interaction' and 'Allergy-drug interaction' alerts in this sample were 88% and 69% respectively. This was in part due to the presence of alerts for interactions between systemic and topical medications and for alerts generated during medication renewals. Refinement in order check logic could lead to lower override rates and increase practitioner acceptance and effectiveness of order checks.
PMCID: PMC2244252  PMID: 12463894
24.  Antihypertensive Medication Selection in Essential Hypertension: Retrospective Studies Using COSTAR 
The choice of antihypertensive therapy for patients with uncomplicated essential hypertension has implications for quality of life, risk of long-term side effects, compliance, and expense. We have used the COSTAR database of the Massachusetts General Hospital Primary Care Program to study prescribing patterns of residents treating patients with uncomplicated essential hypertension and the associated medication costs. We found variation in the categories of antihypertensive agents selected. The average wholesale price of antihypertensive drugs of patients cared for by residents was 35% higher than in patients cared for by staff physicians. Gathering such information retrospectively and concurrently is easily accomplished with COSTAR, and can help to provide both resident and staff physicians with knowledge of the costs of the therapeutic program selected.
PMCID: PMC2245719
25.  The Use of COSTAR in a Retrolective Cohort Study of the Effect of Non-Steroidal Antiinflammatory Agents on Blood Pressure Control 
We have used the Computer-Stored Ambulatory Record (COSTAR) database from the Primary Care Unit of the Massachusetts General Hospital to conduct a retrolective cohort study of the influence of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure control in drug-treated hypertensive patients. The Medical Query Language (MQL) was used to select 91 patients with previously stable blood pressure meeting multiple criteria for study from among the 30,000 in the database, to select controls matched for the demographic and clinical characteristics of these patients, and to collect the relevant clinical information from their COSTAR records. Available blood pressure recordings and prescribing information allows analysis of changes in blood pressure and antihypertensive therapy following NSAID prescriptions in these patients and comparison with matched controls. Such studies are useful in questions where prospective clinical trials are impractical, and the ability to conduct studies of this type is an additional advantage of computer-based medical record systems over paper record systems.
PMCID: PMC2245202

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