By Charles P. Friedman Ph.D., Jeremy C. Wyatt M.B., B.S., D.M., M.R.C.P. (auth.)
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14. Evans D, Patel V (eds): Cognitive Science in Medicine. London: MIT Press, 1989. 15. Van der Lei J, Musen M, van der Does E, in't Veld A, van Bemmel J: Comparison of computer-aided and human review of general practitioners' management of hypertension. Lancet 1991 ;338: 1504-1508. References 15 16. Musen M: The strained quality of medical data. Methods InfMed 1989;28:123-125. 17. Wyatt JC: Clinical data systems. Part I. Data and medical records. Lancet 1994; 344: 1543-47. 18. Leitch D: Who should have their cholesterol measured?
Evaluation is challenging in large part because there are so many options and there is almost never an obvious best way to proceed. The following points bear repeating. 1. In any evaluation setting, there are many potential questions to address. What is asked shapes (but does not totally determine) what is answered. 2. There may be little consensus on what constitutes the best set of questions. 3. There are many ways to address these questions, each with advantages and disadvantages. 4. There is no such thing as a perfect study.
24 Such a resource would employ a knowledge base encoding rules of proper therapeutic practice and would be connected to a hospital information system containing the clinical data about inpatients. When the resource detected a difference between the rules of proper practice and the data about a specific patient, it would issue an advisory to the clinicians responsible for the care of that patient. If comparison-based study of this system's effectiveness employed only global outcome measures, such as length of stay or morbidity and mortality, and the study yielded null results, it would not be clear what to conclude.
Evaluation Methods in Medical Informatics by Charles P. Friedman Ph.D., Jeremy C. Wyatt M.B., B.S., D.M., M.R.C.P. (auth.)