BACKGROUND/RATIONALE:
Computerized clinical reminders (CRs) are in widespread development to improve compliance with established clinical guidelines. Despite promising results from randomized controlled trials of CRs, effectiveness in practice is mixed. Human factors, the study of the interaction of humans and decision support systems in complex environments, may provide new explanations for why CRs are less effective an intervention than anticipated. In prior work, eleven human factors barriers to the use of 9 HIV clinical reminders were identified through ethnographic observation and semi-structured interviews. These barriers included design, organizational, team, provider, and contextual barriers as well as interactions with other supporting artifacts.
OBJECTIVE(S):
The aims are to identify human factors barriers and facilitators to the use of computerized clinical reminders (CRs), assess their prevalence across the VHA, recommend and implement local and national changes to design, implementation, and use, and evaluate the impact of implemented recommendations on the use of clinical reminders.
METHODS:
Three studies combine qualitative and quantitative approaches. Study 1: Ethnographic observations to identify barriers and facilitators to the use of clinical reminders at four sites selected by convenience sampling. Study 2: National provider survey of randomly selected VHA physicians to determine prevalence rates. Study 3: Simulated use in a laboratory setting with resident physicians to evaluate whether a redesign of clinical reminders improves performance and efficiency of use as compared to the current design.
FINDINGS/RESULTS:
Study 1 findings are that barriers to use included (1) workload, (2) poor usability, (3) lack of flexibility, (4) coordination issues between nurses and providers, and (5) a tendency to perform documentation while not with the patient. Facilitators to use included (1) the ability to document problems and receive prompt feedback from those responsible for maintaining the clinical reminders system, (2) location of the computer workstations, (3) improving integration of reminders into “normal” workflow, and (4) strategies for reducing the overall number of reminders at a site. The second and third studies are in the planning stages, with no findings to report at this time.
IMPACT:
Improving the ability to effectively and easily use clinical reminders would likely increase the quality of care provided and increase the efficiency of care for all outpatients in the VHA.
PUBLICATIONS:
Journal Articles
- Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM. Exploring barriers and facilitators to the use of computerized clinical reminders. Journal of The American Medical Informatics Association : JAMIA. 2005; 12(4): 438-47.
- Patterson ES, Doebbeling BN, Fung CH, Militello L, Anders S, Asch SM. Identifying barriers to the effective use of clinical reminders: bootstrapping multiple methods. Journal of Biomedical Informatics. 2005; 38(3): 189-99.
- Spina JR, Glassman PA, Belperio P, Cader R, Asch S. Clinical relevance of automated drug alerts from the perspective of medical providers. American Journal of Medical Quality. 2005; 20(1): 7-14.
