PDF herunterladen
Appl Clin Inform 2012; 03(03): 309-317
DOI: 10.4338/ACI-2012-04-RA-0013
Research Article
Schattauer GmbH

Understanding Why Clinicians Answer or Ignore Clinical Decision Support Prompts

A.E. Carroll
1   Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
2   The Regenstrief Institute for Health Care, Indianapolis, IN
,
V. Anand
1   Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
2   The Regenstrief Institute for Health Care, Indianapolis, IN
,
S. M. Downs
1   Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN
2   The Regenstrief Institute for Health Care, Indianapolis, IN
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received: 19. April 2012

accepted: 18. Juli 2012

Publikationsdatum:
16. Dezember 2017 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Summary

Introduction: The identification of key factors influencing responses to prompts and reminders within a computer decision support system (CDSS) has not been widely studied. The aim of this study was to evaluate why clinicians routinely answer certain prompts while others are ignored. Methods: We utilized data collected from a CDSS developed by our research group – the Child Health Improvement through Computer Automation (CHICA) system. The main outcome of interest was whether a clinician responded to a prompt.

Results: This study found that, as expected, some clinics and physicians were more likely to address prompts than others. However, we also found clinicians are more likely to address prompts for younger patients and when the prompts address more serious issues. The most striking finding was that the position of a prompt was a significant predictor of the likelihood of the prompt being addressed, even after controlling for other factors. Prompts at the top of the page were significantly more likely to be answered than the ones on the bottom.

Conclusions: This study detailed a number of factors that are associated with physicians following clinical decision support prompts. This information could be instrumental in designing better interventions and more successful clinical decision support systems in the future.

Keywords

Clinical decision support systems - CHICA - screening - prompts - EMR
 

  • References

  • 1 Anand V, Biondich PG, Liu G, Rosenman M, Downs SM. Child Health Improvement through Computer Automation: the CHICA system. Stud Health Technol Inform 2004 Pt 1: 187–91. doi: D040004973 [pii].
    PubMedSuche in Google Scholar
  • 2 Anand V, Carroll AE, Downs SM. Automated Primary Care Screening in Pediatric Waiting Rooms. Pediatrics In Press.
    PubMed
  • 3 Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium 2007: 26-30.
    PubMed
  • 4 Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, Spurr C, Khorasani R, Tanasijevic M, Middleton B. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003; 6: 523-530. doi: 10.1197/jamia. M1370.
    PubMedSuche in Google Scholar
  • 5 Biondich PG, Overhage JM, Dexter PR, Downs SM, Lemmon L, McDonald CJ. A modern optical character recognition system in a real world clinical setting: some accuracy and feasibility observations. Proc AMIA Symp 2002: 56–60. doi: D020002364 [pii].
    PubMed
  • 6 Biondich PG, Anand V, Downs SM, McDonald CJ. Using adaptive turnaround documents to electronically acquire structured data in clinical settings. AMIA Annu Symp Proc. 2003: 86-90. doi: D030003628 [pii].
    PubMedSuche in Google Scholar
  • 7 Biondich PG, Downs SM, Anand V, Carroll AE. Automating the recognition and prioritization of needed preventive services: early results from the CHICA system. AMIA Annual Symposium proceedings / AMIA Symposium AMIA Symposium 2005: 51-55.
    PubMed
  • 8 Biondich PG, Downs SM, Carroll AE, Laskey AL, Liu GC, Rosenman M, Wang J, Swigonski NL. Shortcomings in infant iron deficiency screening methods. Pediatrics 2006; 2: 290-294. doi: 10.1542/peds.2004-2103.
    PubMedSuche in Google Scholar
  • 9 Carroll AE, Biondich PG, Anand V, Dugan TM, Sheley ME, Xu SZ, Downs SM. Targeted screening for pediatric conditions with the CHICA system. J Am Med Inform Assoc 2011; 4: 485-490. doi: 10.1136/amiajnl-2011-000088.
    PubMedSuche in Google Scholar
  • 10 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 10: 742-752.
    PubMedSuche in Google Scholar
  • 11 Collins S, Currie L, Patel V, Bakken S, Cimino JJ. Multitasking by clinicians in the context of CPOE and CIS use. Studies in health technology and informatics 2007; Pt 2: 958-962.
    PubMed
  • 12 Downs SM, Uner H. Expected value prioritization of prompts and reminders. Proc AMIA Symp. 2002: 215-219. doi: D020002217 [pii].
    PubMedSuche in Google Scholar
  • 13 Downs SM, Carroll AE, Anand V, Biondich PG. Human and system errors, using adaptive turnaround documents to capture data in a busy practice. AMIA Annu Symp Proc. 2005: 211-215. doi: 58744 [pii].
    PubMedSuche in Google Scholar
  • 14 Downs SM, Biondich PG, Anand V, Zore M, Carroll AE. Using Arden Syntax and adaptive turnaround documents to evaluate clinical guidelines. AMIA Annu Symp Proc. 2006: 214-218. doi: 86547 [pii].
    PubMedSuche in Google Scholar
  • 15 Downs SM, Anand V, Dugan TM, Carroll AE. You can lead a horse to water: physicians’ responses to clinical reminders. AMIA Annu Symp Proc 2010: 167-171.
    PubMed
  • 16 Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Jama 2005; 10: 1223-1238. doi: 10.1001/jama.293.10.1223.
    PubMedSuche in Google Scholar
  • 17 Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R, Taylor R. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood) 2005; 5: 1103-1117. doi: 10.1377/hlthaff.24.5.1103.
    PubMedSuche in Google Scholar
  • 18 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. Bmj 2005; 7494: 765. doi: 10.1136/bmj.38398.500764.8F.
    PubMedSuche in Google Scholar
  • 19 McDonald CJ. Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med 1976; 24: 1351-1355. doi: 10.1056/NEJM197612092952405.
    PubMedSuche in Google Scholar
  • 20 Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson S-A. Computerized clinical decision support for prescribing: provision does not guarantee uptake. Journal of the American Medical Informatics Association 2010; 1: 25-33. doi: 10.1197/jamia. M3170.
    PubMedSuche in Google Scholar
  • 21 Phansalkar S, Edworthy J, Hellier E, Seger DL, Schedlbauer A, Avery AJ, Bates DW. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. Journal of the American Medical Informatics Association 2010; 5: 493-501. doi: 10.1136/jamia.2010.005264.
    PubMedSuche in Google Scholar
  • 22 Piantadosi S. Clinical trials : a methodologic perspective. Hoboken, N. J.: Wiley-Interscience; 2005
    Suche in Google Scholar
  • 23 Seidling HM, Phansalkar S, Seger DL, Paterno MD, Shaykevich S, Haefeli WE, Bates DW. Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support. Journal of the American Medical Informatics Association 2011; 4: 479-484. doi: 10.1136/amiajnl-2010–000039.
    PubMedSuche in Google Scholar