The impact of a health screening flow sheet on the performance and documentation of health screening procedures.

We monitored physician performance of stool occult blood testing and breast exams during health maintenance visits of patients aged 50 or greater, to assess the impact of a physician education program and the use of a health screening flow sheet on performance of these health screening procedures. During the baseline study period, use of these procedures was documented for only about 40% of patients. A physician education program (conferences reviewing appropriate health maintenance screening procedures, and information on the use of a specific health screening flow sheet) did not significantly change the rate of documented physician performance of these procedures. After a health screening flow sheet was introduced into the medical record, the rate of documented performance of these screening tests increased. However, despite the presence of the screening flow sheet in the patient record, most screening evaluations were documented only in the progress notes. These results suggest that the screening flow sheet serves primarily as a memory prompting device. The usefulness of the flow sheet as a patient data storage device appears questionable.