Since 1969 the Massachusetts General Hospital has operated a centralized clinic to monitor outpatients taking oral anticoagulant drugs. The clinic was converted from handwritten records to an on-line computer system eally in 1972, and has since been able to serve a steadily increasing group of patients with less personnel time and at a lower cost.
The computer system has demographic data on each patient and a record of test results and prescribed therapy for each clinic visit. Free-text notes can also be entered. After blood test results are entered by the clinic secretary the computer prints a tabular summary of all patients seen that day, with previous test results and drug schedules and the latest test result. For 85 % of the patients, a dose of the anticoagulant drug and an appointment for the next clinic visit are suggested by the computer, based on data from the three previous clinic visits. A physician reviews the tables and enters any changes he feels are indicated. The computer then prints addressed postcards advising patients how to take their medication and when to return.
Studies comparing the clinic operation before and after the introduction of the computer system showed that the computer produced a significant cost saving due to marked reduction in need for hospital patient records and lower personnel costs, and that patients' recall of their prescribed drug schedule significantly improved.