Integration of a computer-based consultant into the clinical setting

Studies of the attitudes of medical personnel regarding computer based clinical consultation systems have shown that successful programs must be designed not only to satisfy a need for expert level advice but also to fit smoothly into the daily routine of physician/users. Planning for system use should accordingly be emphasized in all aspects or the system design. ONCOCIN is an oncology protocol management system that assists physicians with the management of outpatients enrolled in experimental cancer chemotherapy protocols. ONCOCIN was designed for initial implementation in the Stanford Oncology Day Care Center, where it has been in limited use since May of 1081. The clinic's physicians currently use the system daily in the management of patients with Hodgkin's and non-Hodgkin's lymphoma. This work has allowed us to study physiclan-computer interaction and to explore artificial intelligence research issues. This paper discusses the practical issues to consider when designing a consultation system for physicians and the logistical issues to address when integrating such a system into a clinic setting. We describe how ONCOCIN has addressed these issues, the problems encountered, their resolution, and the lessons learned.