EHR-Integrated Clinical Pathways Promote Education, Confidence, and Save Time for Primary Care Providers

Computerized clinical decision support tools are increasingly necessary and widespread in primary care due to rapidly evolving evidence and shifting clinical guidelines. Clinical pathways are a subtype of clinical decision support tool which aim to link evidence to practice and which require evaluation of benefits and barriers to use to inform user-centered design. The objective was to describe the use and perceived benefits and barriers to evidence-based, disease-specific electronic health record pathways for clinical decision support. Primary care providers at a large integrated health system were surveyed about their use of clinical pathways using an online questionnaire distributed via email in November 2021. Descriptive statistics were estimated and differences in the characteristics and responses by pathway use were assessed using chi-square or Fisher exact tests. The survey response rate was 26% (153/593). There were differences in the response rates between providers by practice type (42% academic versus 54% community; P < 0.001). No difference was found in the demographics of those that used the pathways versus those that did not according to role, age, or length of time in practice. Providers in the academic practice were more likely than those in community practices to have used the pathways. Among providers who used the pathways, 98% agree they have evidence-based information, 98% agree they allow them to take better care of patients, 88% agree they guide clinical-decisions, and 85% agree they save time. The main barrier for those who had used pathways was that they forget about them. Among those who had not used pathways, 35% were unaware that pathways existed. This analysis demonstrates that primary care providers who adopt clinical pathways perceive benefits in several domains. The largest barriers to adoption were that users forgot about pathways or were unaware of them. Future work should focus on dissemination and education, improving tool accessibility, and content optimization to balance complexity with efficiency.