McDonald CJ et al. 1980 "Physician response to computer reminders."

McDonald CJ, Wilson GA, McCabe GP. Physician response to computer reminders. JAMA 1980;244(14):1579-1581.
"A computerized medical record system was designed to detect and remind the responsible clinician about clinical events that might need corrective action. These reminders significantly increased the clinician response rate (in terms of test orders and treatment changes) to the events in question. The addition of relevant medical literature citations to the reminders did not significantly change the clinician response rate as compared with that with reminders alone, nor did it stimulate the physicians to read any of the cited articles kept in an immediately available "library" of reprints."
To assess the impact of clinical reminders on the care provided by physicians.
Tools Used
Type Clinic
Primary care
Other Information
The study took place in the Wishard Memorial Hospital in Indianapolis, Indiana.
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
"At each visit, the [electronic medical record (EMR)] provides a tailored encounter form and a flow sheet summary of each patient's medical history and follows physician-authored management rules to remind the physician about patient conditions requiring his attention. The report containing these reminders is called the 'surveillance' report."
Context or other IT in place
An electronic medical record (EMR) application has been used at the clinic since 1973. "It contains results of most diagnostic studies (e.g., x-ray films, laboratory tests) and records of medication usage for most medicine clinic outpatients."
Workflow-Related Findings
"[J]udging from the strong rejoinders written on some of the surveillance reports, there also appear to be instances in which practitioners disagree fundamentally with the computer's definition of the ideal practice for a given medical circumstance. For example, the computer reminders espouse yearly measures of serum potassium level in all patients receiving potassium-wasting diuretics, whereas some physicians believed the potassium level should be measured only in such patients who were symptomatic or receiving digitalis - a defensible position."
"[T]he average physician responded [by treating the reminder-related condition] to 19.8% of trigger events during control periods and 38.4% of such events during study periods."
The researchers expected "that the practitioner would be piqued sufficiently to read the cited articles that challenged his position. These articles were immediately available on request in the clinic. However, the citations had no effect on either the physicians' practices or on their self-education."
Over the course of the study, none of the cited articles were borrowed by any physician participating in the study from the clinic "library."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 31 providers: nine internal medicine interns, 17 internal medicine residents, and five nurse practitioners.