Mayo-Smith MF et al. 2007 "Factors associated with improved completion of computerized clinical reminders across a large healthcare system."
Reference
Mayo-Smith MF, Agrawal A. Factors associated with improved completion of computerized clinical reminders across a large healthcare system. Int J Med Inf 2007;76(10):710-716.
Abstract
"Objective: To analyze the relationship of completion rates for a standardized set of computerized clinical reminders across a large healthcare system to practice and provider characteristics. Methods: The relationship between completion rate for 13 standardized reminders at 49 primary care practices in the [Veterans Administration] VA New England Healthcare System for a 30-day period and practice characteristics, provider demographics and, via survey, provider attitudes was analyzed. Results: There was no difference in clinical reminder completion rate between staff physicians versus nurse practitioners/physician assistants (87.6% versus 88.1%) but both were better than residents (76.6%, p < 0.0001). With residents excluded, there were no differences between hospital and community-based clinics or between teaching and non-teaching sites. Clinical reminder completion rate was lower for sites that did not fully utilize support staff in completion process versus sites that did (82.4% versus 88.1%, p < 0.0001). Analysis of survey results showed no correlation of completion rate with provider demographics or attitudes towards reminders. However there was significant correlation with frequency of receiving individual feedback on reminder completion (r = 0.288, p = 0.004). Conclusion: Completion of computerized clinical reminders was not affected by a variety of provider characteristics, including professional training, demographics and provider attitude, although was lower among residents than staff providers. However incorporation of support staff into clinic processes and individualized feedback to providers were strongly associated with improved completion. These findings demonstrate the importance of considering practice and provider factors and not just technical elements when implementing informatics tools."
Objective
"To analyze the relationship of completion rates for a standardized set of computerized clinical reminders across a large healthcare system to practice and provider characteristics."
Tools Used
Type Clinic
Primary care
Size
Large
Geography
Urban, suburban, and rural
Other Information
The study took place in the Veterans Administration (VA) New England Healthcare System.
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
For each patient, all activated reminders in the system are judged automatically to be "applicable" or "not applicable" based on data in the electronic patient record. "Each applicable reminder is classified as either 'satisfied' or 'due' at any given time. Applicable and due status of [clinical reminders (CRs)] for a patient is displayed based on clinical data in real-time and is determined based on patient's diagnoses, laboratory results, and demographic characteristics (such as age, gender)....[A]ppropriate documentation...by the clinician can also satisfy the reminder. Due reminders are displayed on the first screen of a patient record in the VA [electronic medical record] EMR. When completing a progress note, clinicians can open a 'dialog box' for an individual CR. Completing the information in the dialog box allows the clinician to complete the reminder and perform clinical documentation in one seamless step. When indicated, the CR also is linked to specific orders, such as a prescription, lab test or consult, so that during the completion of the CR a specific order is generated."
Context or other IT in place
Electronic medical records (EMR)
Workflow-Related Findings
There was "no difference [in the rates of addressing the reminders]
between staff physicians compared to nurse practitioners/physician assistants (87.6% versus 88.1%) but both were better than residents (76.6%, p < 0.0001)."
between staff physicians compared to nurse practitioners/physician assistants (87.6% versus 88.1%) but both were better than residents (76.6%, p < 0.0001)."
"Comparison of those sites where there was immediate 'real time' CR data entry by clinic support staff to those that did not revealed that sites which had this practice had a significantly higher completion rate (88.1% versus 82.4%, p < 0.0001)....Those sites that did not fully use support staff to complete reminders and enter the data into the EMR immediately, before the patient saw the primary care provider, had lower completion. Improved performance in the clinics that did use this approach could arise from the
elimination of steps in the process, such as creating a handwritten results which then must be passed to the clinician for EMR entry, thereby improving the reliability of the process. Alternatively it may free the provider from the necessity of performing certain steps altogether, and shift the task to a staff with more time and more interest in the particular tasks."
elimination of steps in the process, such as creating a handwritten results which then must be passed to the clinician for EMR entry, thereby improving the reliability of the process. Alternatively it may free the provider from the necessity of performing certain steps altogether, and shift the task to a staff with more time and more interest in the particular tasks."
"There was a significant correlation with the perceived frequency of receiving feedback on completion of reminders ... (r = 0.288, p = 0.004)."
Study Design
Only postintervention (no control group)
Study Participants
The study included all primary care providers in 49 primary care practice sites affiliated with the eight medical centers of the VA New England Healthcare System.