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Release: March 7, 2000

UI develops Internet-based system to aid in applying tuberculosis prevention guidelines

IOWA CITY, Iowa – Trying to decipher complex medical guidelines can be a challenging, time-consuming task for many physicians. However, that may not be the case any more for tuberculosis prevention and care. University of Iowa Health Care providers have designed a new Internet-based tool in hopes of making the process easier and more accurate.

The Decision-Support System (DSS) is a convenient way to better use the established guidelines for preventive therapy that were created by the Centers for Disease Control and the American Thoracic Society. The DSS delivers patient-specific recommendations based on physician-delivered patient-specific information. Within a matter of a couple of clicks of the computer mouse, physicians can have the information they need to care for patients.

The DSS is better than the alternative, thumbing through printed guideline references. According to a study in the current issue of the journal Medical Decision Making, a group of general internal medicine residents who used the DSS came to the right therapy decision 95.8 percent of the time. A second group of general internal medicine residents who relied only on printed materials arrived at the correct therapy decision 56.6 percent of the time. The residents who used the DSS were able to get their answers to each case in an average of 90 seconds and three mouse clicks.

Charles Dayton, UI Clinical Pharmacy Specialist, began developing the DSS for tuberculosis guidelines in 1995. The system was up and running in December 1998.

"A lot of negative press comes out about the Internet, but it can be a very powerful tool if the project is well thought out and carefully planned," said Michael Peterson, M.D., UI associate professor of internal medicine and a collaborator on the DSS project.

Peterson added that clinicians cannot carry guideline information around with them all the time. However, most doctors have easy access to the Internet.

The UI tuberculosis tool appears to be catching on. Douglas Hornick, M.D., UI associate professor (clinical) of internal medicine and a tuberculosis expert, used to get phone calls daily from general physicians asking how to deal with individuals who have a response to the traditional tuberculosis skin test.

"Now, I don't get nearly as many calls," Hornick said.

In addition to helping physicians in their treatment decisions, the tool is useful for teaching other health care professionals more about tuberculosis, Dayton added.

The DSS tool is also adaptive to change, Hornick said. When the guidelines change, as they will next month, the DSS can be revised immediately to reflect the changes whereas it would take weeks or months for printed materials to be available in most doctors' offices.

"It has the ability to be used in real time," said J. Scott Ferguson, M.D., an associate in the UI department of internal medicine who helped with the study appearing in the Medical Decision Making journal.

Tuberculosis is not the only condition to which the UI health care providers have applied DSS. As Dayton explained, the tool is really a template that can be adapted to any condition or disease for which there are guidelines. The UI developers have already set up a similar system for asthma and are currently working on developing one for community-acquired pneumonia.

"This works for anything," Peterson said. "You just have to build it simple, intuitive and responsive."

The address for the tuberculosis web site is http://www.vh.org/Providers/TeachingFiles/PulmonaryCoreCurric/TBCase/AssessmentTool/AssessmentPage1.html. The address for the asthma web site is http://www.vh.org/Providers/ClinGuide/AsthmaIM/Default.html

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.