Sittig DF et al. 2006 "A survey of factors affecting clinician acceptance of clinical decision support."
Reference
Sittig DF, Krall MA, Dykstra RH, et al. A survey of factors affecting clinician acceptance of clinical decision support. BMC Med Inf Decis Making 2006;6:6.
Abstract
"Background: Real-time clinical decision support (CDS) integrated into clinicians' workflow has the potential to profoundly affect the cost, quality, and safety of health care delivery. Recent reports have identified a surprisingly low acceptance rate for different types of CDS. We hypothesized that factors affecting CDS system acceptance could be categorized as relating to differences in patients, physicians, CDS-type, or environmental characteristics. Methods: We conducted a survey of all adult primary care physicians (PCPs, n = 225) within our group model Health Maintenance Organization (HMO) to identify factors that affect their acceptance of CDS. We defined clinical decision support broadly as "clinical information" that is either provided to you or accessible by you, from the clinical workstation (e.g., enhanced flow sheet displays, health maintenance reminders, alternative medication suggestions, order sets, alerts, and access to any internet-based information resources). Results: 110 surveys were returned (49%). There were no differences in the age, gender, or years of service between those who returned the survey and the entire adult PCP population. Overall, clinicians stated that the CDS provided "helps them take better care of their patients" (3.6 on scale of 1: Never - 5: Always), "is worth the time it takes" (3.5), and "reminds them of something they've forgotten" (3.2). There was no difference in the perceived acceptance rate of alerts based on their type (i.e., cost, safety, health maintenance). When asked about specific patient characteristics that would make the clinicians "more", "equally" or "less" likely to accept alerts: 41% stated that they were more (8% stated "less") likely to accept alerts on elderly patients (> 65 yrs); 38% were more (14% stated less) likely to accept alerts on patients with more than 5 current medications; and 38% were more (20% stated less) likely to accept alerts on patients with more than 5 chronic clinical conditions. Interestingly, 80% said they were less likely to accept alerts when they were behind schedule and 84% of clinicians admitted to being at least 20 minutes behind schedule "some", "most", or "all of the time". Conclusion: Even though a majority of our clinical decision support suggestions are not explicitly followed, clinicians feel they are of benefit and would be even more beneficial if they had more time available to address them."
Objective
"To begin exploring [the] other potential factors affecting clinician acceptance of clinical decision support at the point of care."
Type Clinic
Primary care
Type Specific
Family practice and internal medicine
Size
Large
Geography
Urban and suburban
Type of Health IT
Decision support system
Type of Health IT Functions
The authors "defined clinical decision support as 'clinical information that is either provided to you or accessible by you, from the ... clinical workstation'. [They] consider enhanced information displays such as flow sheets, health maintenance reminders, alternative medication suggestions, order sets or smart sets, alerts, and access to any internet-based information resources like the KPNW Clinical Library as clinical decision support."
Context or other IT in place
An electronic medical records (EMR) system has been in place since 1997.
Workflow-Related Findings
"When asked to "rate" the clinical decision support..., respondents were fairly positive, reporting that "It helps me take better care of my patients." (3.5), "It's worth the time it takes." (3.5), and "It reminds me of something
I had forgotten about." (3.1)."
I had forgotten about." (3.1)."
"There was no difference in clinicians' response to the question of how often they accept each of the three different types of clinical decision support alerts (cost-related: 3.6; safety-related: 3.5; health maintenance: 3.4)."
"When asked about specific uses of the clinical information system in the examination room, respondents reported that they were most likely to use it to "Look up patient information." (3.9), "Enter orders for the patient." (3.8),
"Show the patient a graph of his/her laboratory values, [weight] wt, blood pressure, or growth" (2.9), "Use KPNW Clinical Library or other reference information" (2.4), and "Enter their progress/visit note" (2.4)."
"Show the patient a graph of his/her laboratory values, [weight] wt, blood pressure, or growth" (2.9), "Use KPNW Clinical Library or other reference information" (2.4), and "Enter their progress/visit note" (2.4)."
"Clinicians stated that if allowed, they would decrease (61%) the number of alerts (which they estimated at 7.6 alerts/0.5 day shift) they were receiving."
Female providers "were more likely to accept "safety-related" alerts (f: 3.76 vs. m: 3.39), more often "relieved" to get an alert (f: 2.57 vs. m: 2.16), [and] more often felt "empowered" when receiving an alert (f: 2.66 vs. m: 2.32)."
"There were no differences in the reported likelihood that either those who were behind [in their schedule] a lot or a little regarding their acceptance of any of the alert types."
"Several alerts that come up at the wrong point in the work flow, for example, alerts that display whenever a clinician opens a patient's chart or those that appear when the clinician is charting a "telephone encounter" since in these cases the patient is not even in the presence of the clinician."
"Respondents, who had been with [the clinic] for 1-3 years, were more likely to report feeling relieved [by an alert] (1: 66% vs. 15: 30%), feeling grateful [for an alert] (1: 91% vs. 15: 69%), ... and to admit that [the alert] "reminded them" of something they had forgotten (1: 91% vs. 15: 69%), "some", "most" or "all" of the time, than those who had been with KPNW for more
than 15 years."
than 15 years."
Study Design
Only postintervention (no control group)
Study Participants
The survey was sent to all 225 adult primary care physicians working for "Northwest Permanente, the physician group associated with Kaiser Permanente Northwest in Portland, OR."