Fung CH 2006 "Computerized condition-specific templates for improving care of geriatric syndromes in a primary care setting."

Fung CH. Computerized condition-specific templates for improving care of geriatric syndromes in a primary care setting. J Gen Intern Med 2006;21(9):989-994.
"Introduction: As the U.S. population ages, primary care clinicians (PCCs) will encounter more patients with geriatric syndromes, such as urinary incontinence (UI) and falls. Yet, current evidence suggests that care of these conditions does not meet expected standards and that PCCs would benefit from tools to improve care of these conditions. Little is known about the role of computerized condition-specific templates for improving care of geriatric syndromes.
AIM: We sought to develop and assess the usefulness of condition-specific computerized templates in a primary care setting.
SETTING: A large academic Veterans Affairs medical center.
PROGRAM DESCRIPTION: We developed and tested the usefulness of 2 condition-specific computerized templates (UI and falls) that could be added on to an existing electronic health record system.
PROGRAM EVALUATION: Semi-structured interviews were used to identify barriers to use of computerized templates. Usefulness and usability were assessed through a randomized-controlled trial, involving standardized patients.
DISCUSSION: Use of condition-specific templates resulted in improved history and physical exam assessment for both UI and falls (P<.05). Our computerized, condition-specific templates are a promising method of improving care of geriatric conditions in a primary care setting, but require improvement in usability before widespread implementation."

"To develop and assess the usefulness of condition-specific computerized templates in a primary care setting."

Tools Used
Type Clinic
Primary care
Other Information
The study took place at a Veterans Health Administration medical center in Los Angeles, California.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
"The applications being analyzed in this study were two templates designed to help with documentation and data collection for geriatric patients with conditions of urinary incontinence (UI) and falls. The templates included a series of prompts for specific information that were automatically converted into text and inserted into the patient note. Subcomponents of the template could be inserted separately, such as UI history, UI physical exam, UI diagnostics, etc. All entries were required to be active responses (no defaults)."
Workflow-Related Findings
While clinicians "found the templates moderately helpful, they seemed somewhat ambivalent as to ease of use, with mean responses in the 3 to 4 range (1 = strongly disagree and 7 = strongly agree). The subjects thought that the templates were relatively easy to learn to use (mean 5.0) and that the information on the templates was easy to understand (mean 5.2). The subjects did not feel that the speed of the computer impeded use of the templates (mean 1.0)."
"One of the main concerns raised was perceived unnecessary duplication of information that is already included in clinic notes."
Significantly fewer clinicians in the templates group agreed with the statement that "In general, I need to make notes on paper that I later use to complete templates."
Clinicians using the templates were more likely to gather a targeted history on UI status including five important topics: characteristics of voiding, ability to get to the toilet, prior treatment for UI, the importance of the problem to the patient, and mental status.
Clinicians using the templates were more likely to document basic fall history including circumstances, chronic conditions, medications, and mobility.
"Templates may be particularly useful for prompting clinicians to obtain appropriate elements of the history, because clinicians can ask the prompted questions as they are typing their note...Results suggest that overall the templates prompted clinicians to ask important questions and to perform physical exam elements related to Ul and falls."
Study Design
Randomized controlled trial (RCT)
Study Participants
The study participants included 16 primary care clinicians who had an interest in IT and its relation to patient care. All study participants were with the VHA for at least six months.