Integrative medicine smart phrase pilot study: Evaluating an EHR tool to improve providers' attitudes, knowledge and...

While many patients use herbal and dietary supplements (H/DS) for wellness, disease prevention and treatment, providers still cite a lack of resources and formal training as barriers to responding to patients' inquiries about H/DS. Although the federal government, academic institutions and the private sector now offer more opportunities for education and research on H/DS, greater support in real time is needed to facilitate providers during the clinical encounter.

This small, pilot study evaluates the effects of implementation of smart phrases in the electronic health record (EHR) and an educational intervention on providers' knowledge, attitude and use of H/DS in the clinical encounter.

The study was conducted at The Institute for Family Health (IFH), a Federally Qualified Health Center and academic health center which operates the Department of Family Medicine and Community Health in affiliation with the Icahn School of Medicine at Mount Sinai. Baseline and post-intervention surveys were conducted to explore providers' attitudes, knowledge and use of integrative medicine (IM) smart phrases on H/DS.

Providers' awareness of smart phrases of H/DS, knowledge of the content, confidence in using smart phrases to discuss H/DS, self-reported use of smart phrases were measured.

A total of 32 subjects participated in the intervention and completed the baseline survey. Only half of the participants were familiar with the IM smart phrases in our system and 12.5% felt they were aware of the information covered in these smart phrases. Eighteen of 32 participants completed the post-intervention assessment. The intervention was successful in statistically increasing participants' self-reported awareness of the information covered in the IM smart phrases (p<0.01). Increased confidence in using IM smart phrases to initiate patients on a new supplement showed statistical significance (p=0.03). There were no clear patterns in reported behavior changes following the training with the exception of a significant increase in the self-reported frequency of past month use of IM smart phrases during a patient visit (p=0.01). Lastly, there were no changes in the frequency of smart phrase use in the EHR.

The implementation and adoption of evidence-based use of H/DS in the clinical encounter requires a sustained educational component to make the availability of smart phrases via technology (EHR) an effective strategy.