The effects of on-screen, point of care computer reminders on processes and outcomes of care

By K. Shojania, Alison Jennings, A. Mayhew, C. Ramsay, M. Eccles, Jeremy M. Grimshaw. Cochrane Database of Systematic Reviews, 2009

520 citations recorded by the source corpus.

Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

Subfields: Applied Psychology, Family Practice, Health Information Management

View Paper: https://www.semanticscholar.org/paper/ee782612804528d3915924dbbb24a33454b63a20

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Applied Psychology

1. Byron J. Powell
2. Gregory A. Aarons
3. Jeremy M. Grimshaw
4. M. Eccles
5. Susan Michie

In Family Practice

1. Gregory A. Aarons
2. M. Eccles

In Health Information Management

1. Gregory A. Aarons
2. Aziz Sheikh
3. Kathrin M. Cresswell
4. Claudia Pagliari

Citations in the corpus

• Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda (2019, background): “These strategies vary in complexity, from discrete or single component strategies (6, 7) such as computerized reminders (8) or audit and feedback (9) to multifaceted implementation strategies that combine two or more discrete strategies, some of which have been branded and tested using rigorous desi”
• The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview (2011, background): “Our final selection of 53 reviews provided the main empirical evidence base in relation to assessing the impact of the selected eHealth technologies (see Table 1 for our critical appraisal of these studies) [15–67], full details of which can be found in Table S2.”
• Knowledge translation of research findings (2012, background): “EPOC defines reminders as ‘patient or encounter specific information, provided verbally, on paper or on a computer screen, which is designed or intended to prompt a health professional to recall information [42].”
• The impact of health information technology on patient safety (2017, background): “11 A Cochrane systematic review 12 concluded that the use of on screen reminders for physicians resulted in minor to modest improvements in process adherence, medication ordering, vaccination, laboratory ordering and clinical outcomes.”