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Impact of clinical reminder redesign on physicians' priority decisions
Sze-Jung Wu1, Mark R Lehto, Yuehwern Yih
1School of Industrial Engineering, Purdue University , West Lafayette, IN 47907, USA.
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.
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