Journal of Clinical Oncology, Vol 3, 1409-1417, Copyright © 1985 by American Society of Clinical Oncology
Improvements in data collection through physician use of a computer- based chemotherapy treatment consultant
DL Kent, EH Shortliffe, RW Carlson, MB Bischoff and CD Jacobs
The impact of a computer-based data management system on the completeness
of clinical trial data was studied before and after the system's
introduction in an oncology clinic. Physicians use the system, termed
ONCOCIN, to record data during patient visits and to receive advice about
treatment and tests required by experimental cancer protocols. Although
ONCOCIN does not force the user to enter all data expected by the protocol,
after its introduction there was improvement in the recording frequency of
such data. The percentage of expected physical findings recorded increased
from 74% to 91% (P less than .05), toxicity history from less than 1% to
45% (P less than .01), general chemistry results from 36% to 82% (P less
than .01), x-ray results from 44% to 73% (P less than .01), and physicians'
assessments of overall disease activity and Karnofsky performance status
from 73% to 91% (P less than .05). Analysis of the steps in data collection
and their contribution to loss of data suggests that observations or test
ordering which are dependent on the physician are most improved by the
system. Furthermore, analysis of post-ONCOCIN visits when the system was
unavailable suggests that the recording of physician-dependent data
(physical findings and assessments of disease activity and performance
status) is likely to revert to pre-ONCOCIN levels if the system is not used
routinely. The results show that ONCOCIN can greatly enhance recovery of
those data expected for chemotherapy protocol patients. The program's
interaction with the physician is central to its effectiveness in data
collection, especially for data that arise directly from the
patient-physician encounter.
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