Reminders to Physicians from an Introspective Computer Medical Record

TLDR

The study aimed to assess how 1,490 computer‑generated reminder messages influence physician behavior by randomly assigning general‑medicine residents to intervention or control groups. A computer‑stored medical record system that stores diagnostic studies and treatments and triggers reminders based on physician‑written rules was used to deliver the 1,490 reminders to residents. Residents receiving reminders responded to 49 % of the six suggested actions versus 29 % for controls (p < 0.0001), with significant improvements in preventive care and a strong correlation between study‑group intentions and action uptake (p < 0.03, r² = 0.33), while control intentions did not predict responses.

Abstract

We developed a computer-stored medical record system containing a limited set of the total clinical data base—primarily diagnostic studies and treatments. This system responds to its own content according to physician-authored reminder rules. To determine the effect of the reminder messages generated by 1490 rules on physician behavior, we randomly assigned practitioners in a general medicine clinic to study or control groups. The computer found indications for six different actions per patient in 12 467 patients during a 2-year study: 61 study group residents who received computer reminders responded to 49% of these indications; 54 control group residents, to only 29% (p < 0.0001). Preventive care (occult blood testing, mammographic screening, weight reduction diets, influenza and pneumococcal vaccines) was affected. The intentions of the study group to use a given action for an indication predicted their response to the indications (p < 0.03, r 2 = 0.33). The intentions of the control residents did not.