Ornstein S et al. 1995 "Implementation and evaluation of a computer-based preventive services system."
Reference
Ornstein S, Garr D, Jenkins R, et al. Implementation and evaluation of a computer-based preventive services system. Fam Med 1995;27(4):260.
Abstract
"BACKGROUND AND OBJECTIVES: Insufficient attention has been paid to the role that modern information systems can play in improving the delivery of and education about preventive services in family medicine training and practice sites. From September 1990-September 1993, the Department of Family Medicine at the Medical University of South Carolina conducted a demonstration project designed to develop, implement, and evaluate a comprehensive, computer-based preventive services delivery and educational system, based on the recommendations in the US Preventive Services Task Force (USPSTF) Report. METHODS: A computer-based patient record (CPR) system was implemented. The system had sophisticated preventive services tracking and reminder, physician, and patient education features. Twenty-nine basic USPSTF recommendations were incorporated in the system. An extensive physician education series was also implemented. A multi-method evaluation system, including patient exit surveys, physician interviews, and practice audits was used to evaluate and design improvements to the CPR and education systems. RESULTS: Although the system initially had no effect on patient perceptions about the frequency of preventive services delivery, there was reasonable concordance between patient desires and physician behavior for the discussion of preventive services (Kappa = .5 to .6). Physician acceptance of the system was good--in 1992, 30% of physicians used the preventive services reminders in most of their patient visits, and in 1993, 88% of physicians reported more frequent use. Practice audits from February 1992-July 1993 showed increased adherence with all seven counseling services, 10 of 15 screening services, and one of five immunization services. CONCLUSIONS: A CPR-based preventive services system coupled with an adaptable physician education about and delivery of preventive services. an ideal solution to improving the education about and delivery of preventive services."
Objective
To "develop, implement, and evaluate a comprehensive, computer-based preventive services delivery and educational system, based on the recommendations in the U.S. Preventive Services Task Force (USPSTF) Report."
Type Clinic
Primary care
Type Specific
Family practice
Size
Large
Geography
Urban
Other Information
The study took place at the Department of Family Medicine at the Medical University of South Carolina.
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
The system provides "physician reminders at every patient visit for deficient preventative services, and annual birthday reminder letters to patients that alert them to needed preventative services."
Context or other IT in place
An electronic medical record (EMR) system that has the "ability to track up to 13 preventative services per age and sex group" was already in place The system also provided patient educational resource materials for 29 selected preventative services.
Workflow-Related Findings
Patient exit surveys showed that physicians did not discuss preventative services more often after the implementation of the reminder system. 56 percent of "patients reported that their physician had discussed one or more preventative services with them during their visit" prior to implementation, and 46 percent of patients reported this after implementation.
A physician survey indicated that 30 percent of physicians used the preventative services reminders in nearly all appointments, 22 percent used them infrequently, and 48 percent used them sometimes.
"Fifteen of 17 respondents (88%) ... reported they understood the message about each of the counseling interventions they should deliver to their patients."
"Fifteen of 17 respondents (88%) indicated more frequent use of the ... preventative service reminders, including encouraging patients to look at the preventative services reminders displayed on the computer screen."
In an 18-month period, "improvements occurred in all counseling services, for screening services such as amblyopia and strabismus, blood pressure measurement, urinalysis, hemoglobin, breast examination, hearing, visual acuity, glaucoma testing, transient ischemic attack symptom detection, thyroid function testing and for adult diptheria and tetanus immunization. Little change was observed for other immunization services and for screening services such as fecal occult blood, papanicolaou smears, and mammography. Height and weight measurement and cholesterol screening declined slightly."
Study Design
Pre-postintervention (no control group)
Study Participants
Participants in the study were physicians and patients attending the clinic during the study period.