Impact of site-specific customizations on physician compliance with guidelines.

Developed and implemented in the Service d'Oncologie Médicale Pitié-Salpêtrière (Paris, France) as a computer-based guideline system on breast cancer, OncoDoc has already demonstrated high physician compliance rates. To assess how the system could be reused in another institution which was not involved in the development process, we have conducted a new experimentation at the Institut Gustave Roussy. Minor site-specific customizations of the knowledge base have been performed. After four months, 127 cases were recorded. Results showed that there was no significant difference of physician compliance with OncoDoc (85%) when site-specific recommendations were, or not, available, although local recommendations were chosen preferably (55%), thus legitimating the adaptation