User centered clinical decision support tools: adoption across clinician training level

Area of Science:

• Health Informatics
• Medical Education
• Clinical Practice

Background:

• Clinical decision support (CDS) tool adoption is a key goal of healthcare initiatives like the Meaningful Use program.
• Physician adoption rates are influenced by personal, organizational, and clinical factors, with younger physicians often being early adopters.

Purpose of the Study:

• To investigate the differences in the adoption of CDS tools based on healthcare providers' training levels.

Main Methods:

• A randomized controlled trial involving 168 residents and attending physicians at an academic medical institution.
• The intervention group accessed a CDS tool via the electronic health record (EHR) during patient encounters.
• EHR data analyzed CDS tool interaction, including alert acceptance and calculator completion, using bivariate tests and generalized estimating equation (GEE) modeling.

Main Results:

• First-year residents demonstrated higher completion rates for CDS calculators and medication order sets compared to other training levels.
• Attending physicians showed lower acceptance rates for initial CDS alerts (29.3%) and medication order sets (22.4%).
• Attendings prescribed antibiotics more frequently (37.1%) during CDS encounters than residents.

Conclusions:

• Significant variation exists in CDS tool adoption across different physician training levels.
• Attending physicians exhibited lower engagement with CDS tools, leading to increased antibiotic prescribing.
• Tailoring CDS tools to specific clinician training levels is recommended for improved utilization and outcomes.