AMIA Annu Symp Proc - You can lead a horse to water: physicians' responses to clinical reminders.

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Resumo

CKGROUND: Meaningful use of health information technology (HIT) requires the use of clinical decision support systems (CDSS). However, the effectiveness of CDSS depends on physician compliance with clinical reminders which is known to be highly variable. Our objective was to evaluate physician adherence to clinical reminders from a CDSS designed to maximize features known to improve practice.METHODS: We evaluated physicians' compliance with clinical reminders generated by the Child Health Improvement through Computer Automation (CHICA) system, a pediatric CDSS that generates scannable paper forms that are completed by patients, staff and physicians during routine care. The forms provide tailored reminders and collect coded clinical data during routine care. We examined CHICA's database to assess the rates of response by patients and physicians to questions and reminders generated by the system. Results showed that while patients answered, on average, 60.6% of 1,351,896 questions generated by the system over 5 years, physicians responded to only 42.9% of 343,949 alerts and reminders over the same period of time. Response rates appeared to be inversely related to both the complexity and sensitivity of the topic.DISCUSSION: Poor physician adherence to clinical reminders in this optimized system reduces effectiveness of the system and poses some liability issues. Strategies to alert physicians to the reminders of highest import are needed.

Resumo Limpo

ckground meaning use health inform technolog hit requir use clinic decis support system cdss howev effect cdss depend physician complianc clinic remind known high variabl object evalu physician adher clinic remind cdss design maxim featur known improv practicemethod evalu physician complianc clinic remind generat child health improv comput autom chica system pediatr cdss generat scannabl paper form complet patient staff physician routin care form provid tailor remind collect code clinic data routin care examin chica databas assess rate respons patient physician question remind generat system result show patient answer averag question generat system year physician respond alert remind period time respons rate appear invers relat complex sensit topicdiscuss poor physician adher clinic remind optim system reduc effect system pose liabil issu strategi alert physician remind highest import need

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