A Core Benefit of Electronic Health IT Questioned

A study titled, "Effect of point-of-care computer reminders on physician behaviour: a systematic review", appearing in the Canadian Medical Association Journal (CMAJ) recently reported that except for a "homegrown" EHR system, "Computer reminders to physicians regarding prescribing produce much smaller improvements than initially expected."

The study notes that, "Computerized systems for entering orders and electronic medical records are the two most widely recommended improvements in health care. These systems offer the opportunity to improve practice by delivering reminders, such as prescribing alerts, to clinicians caring for patients."

Other improvements touted for computer reminders are improved prescription of medications, reminders for vaccinations, ordering of tests, etc.

However, the study which involved a systematic review of 28 clinical trials and was "conducted to measure the expected improvements in patient care with the help of computer reminders sent to physicians during their routine electronic ordering or charting activities ... found that computer reminders improved processes of care by a median of 4.2%, with the best outcome showing a median improvement of only 5.6%."

Dr. Kaveh G. Shojania of the University of Toronto and one of the study coauthors said that, "Computer reminders typically increased adherence to target processes of care by amounts below thresholds for clinically significant improvements."

The clinical information system at Brigham and Women’s Hospital did show a 16.8% improved adherence to processes of care, however. Yet, the researchers also note that, "..we do not know if the success of computer reminders at this institution reflects the design of reminders requiring user responses, other features of the computer system or perhaps institutional culture."

The study concludes that "until further research identifies improved design and reminder features that lead to worthwhile improvements in care, 'implementing these costly technologies will be an expensive exercise in trial and error.' "

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