Impact of Clinical Reminder Redesign on Physicians’ Priority Decisions
S.-j. Wu (1), M. R. Lehto (1), Y. Yih (1), J. J. Saleem (2, 3, 4), B. N. Doebbeling (2, 4, 5)
(1) School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA; (2) VA HSR&D Center on Implementing Evidencebased Practice, Roudebush VAMC, Indianapolis, IN 46202, USA; (3) School of Engineering & Technology, IUPUI, Indianapolis, IN 46202, USA; (4) IU Center for Health Services & Outcomes Research, Regenstrief Institute, Indianapolis, IN 46202, USA; (5) Department of Medicine, IU School of Medicine, Indianapolis, IN 46202, USA
Summary Objective: Computerized clinical reminder (CCR) systems can improve preventive service delivery byproviding patient-specific reminders at the point of care. However, adherence varies between individualCCRs and is correlated to resolution time amongst other factors. This study aimed to evaluate howa proposed CCR redesign providing information explaining why the CCRs occurred would impact providers’prioritization of individual CCRs.Design: Two CCR designs were prototyped to represent the original and the new design, respectively.The new CCR design incorporated a knowledge-based risk factor repository, a prioritization mechanism,and a role-based filter. Sixteen physicians participated in a controlled experiment to compare theuse of the original and the new CCR systems. The subjects individually simulated a scenario-based patientencounter, followed by a semi-structured interview and survey.Measurements: We collected and analyzed the order in which the CCRs were prioritized, the perceivedusefulness of each design feature, and semi-structured interview data.Results: We elicited the prioritization heuristics used by the physicians, and found a CCR system neededto be relevant, easy to resolve, and integrated with workflow. The redesign impacted 80% of physiciansand 44% of prioritization decisions. Decisions were no longer correlated to resolution time giventhe new design. The proposed design features were rated useful or very useful.Conclusion: This study demonstrated that the redesign of a CCR system using a knowledge-based riskfactor repository, a prioritization mechanism, and a role-based filter can impact clinicians’ decisionmaking. These features are expected to ultimately improve the quality of care and patient safety.
Decision Support, HIT, Health information technology, computerized clinical reminders