Impact of clinical reminder redesign on physicians' priority decisions

Sze Jung Wu, Mark R. Lehto, Yuehwern Yih, Jason J. Saleem, B. N. Doebbeling

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objective: Computerized clinical reminder (CCR) systems can improve preventive service delivery by providing patient-specific reminders at the point of care. However, adherence varies between individual CCRs and is correlated to resolution time amongst other factors. This study aimed to evaluate how a 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 the use of the original and the new CCR systems. The subjects individually simulated a scenario-based patient encounter, followed by a semi-structured interview and survey. Measurements: We collected and analyzed the order in which the CCRs were prioritized, the perceived usefulness of each design feature, and semi-structured interview data. Results: We elicited the prioritization heuristics used by the physicians, and found a CCR system needed to be relevant, easy to resolve, and integrated with workflow. The redesign impacted 80% of physicians and 44% of prioritization decisions. Decisions were no longer correlated to resolution time given the 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 risk factor repository, a prioritization mechanism, and a role-based filter can impact clinicians' decision making. These features are expected to ultimately improve the quality of care and patient safety.

Original languageEnglish (US)
Pages (from-to)466-485
Number of pages20
JournalApplied Clinical Informatics
Volume1
Issue number4
DOIs
StatePublished - 2010
Externally publishedYes

Keywords

  • Computerized clinical reminders
  • Decision support
  • HIT
  • health information technology

ASJC Scopus subject areas

  • Health Informatics
  • Computer Science Applications
  • Health Information Management

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