Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations

Abstract

OBJECTIVES: Only half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation. MEASUREMENTS: The tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N=20) and intervention (after pilot; N=20) patients. Consultants wrote notes containing recommendations for all study patients, and entered electronic recommendations only for intervention patients. We analyzed all recommendations and surveyed hospitalists. RESULTS: A total of 249 recommendations were made for intervention patients versus 192 for controls (p<0.05). Of all recommendations about intervention patients, 78% were implemented, compared to 59% for controls (p=0.01). Of the intervention recommendations, 77% were entered electronically using our tool; of these, 86% were implemented. All 24 survey respondents indicated that the system improved quality, saved time, and should be expanded. CONCLUSION: Consultant recommendations were implemented 30% more often when there was electronic facilitation of recommendations.