title: Underutilization of information and knowledge in everyday medical practice: evaluation of a computer-based solution.
abstract: BACKGROUND
  The medical history is acknowledged as the sine qua non for quality medical care because recognizing problems is pre-requisite for managing them. Medical histories typically are incomplete and inaccurate, however. We show here that computers are a solution to this issue of information gathering about patients. Computers can be programmed to acquire more complete medical histories with greater detail across a range of acute and chronic issues than physician histories.
  
  
  METHODS
  Histories were acquired by physicians in the usual way and by a computer program interacting directly with patients. Decision-making of what medical issues were queried by computer were made internally by the software, including determination of the chief complaint. The selection of patients was from admissions to the Robert-Bosch-Hospital, Stuttgart, Germany by convenience sampling. Physician-acquired and computer-acquired histories were compared on a patient-by-patient basis for 45 patients.
  
  
  RESULTS
  The computer histories reported 160 problems not recorded in physician histories or slightly more than 3.5 problems per patient. However, physicians but not the computer reported 13 problems. The data show that computer histories reported problems across a range of organ systems, that the problems detected by computer but not physician histories were both acute and chronic and that the computer histories detected a significant number of issues important for preventing further morbidity.
  
  
  CONCLUSIONS
  A combination of physician and computer-acquired histories, in non-emergent situations, with the latter available to the physician at the time he or she sees the patient, is a far superior method for collecting historical data than the physician interview alone.
authors.affiliation: IDM Foundation Institute of Digital Medicine, Am Kriegsbergturm 44, D-70192 Stuttgart, Germany. david.zakim@idm-foundation.org
authors.forename: David
authors.initials: D
authors.lastname: Zakim
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.forename: Peter
authors.initials: P
authors.lastname: Fritz
authors.forename: Mark Dominik
authors.initials: MD
authors.lastname: Alscher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D017060:Patient Satisfaction; D012984:Software; D055815:Young Adult