Reminders to physicians from an introspective computer medical record. A two-year randomized trial

Area of Science:

• Medical Informatics
• Clinical Decision Support Systems
• Health Services Research

Background:

• Electronic medical record (EMR) systems can store clinical data.
• Physician-authored rules can trigger reminders within EMRs.
• The impact of these reminders on physician behavior requires evaluation.

Purpose of the Study:

• To assess the effect of computer-generated reminder messages on physician behavior.
• To determine if EMR-based reminders improve adherence to clinical indications.
• To evaluate the impact on preventive care practices.

Main Methods:

• A computer-stored medical record system with 1490 reminder rules was utilized.
• Practitioners in a general medicine clinic were randomized into study (reminders) and control groups.
• Physician responses to computer-identified indications over a 2-year period were analyzed.

Main Results:

• Study group residents responded to 49% of indications, significantly higher than the control group's 29% (p < 0.0001).
• Reminders positively affected preventive care actions, including screenings and vaccinations.
• Physician intentions predicted response rates in the study group (p < 0.03, r2 = 0.33).

Conclusions:

• Computer-stored medical record systems with reminder rules can effectively improve physician adherence to clinical guidelines.
• EMR-based reminders are a valuable tool for enhancing preventive care delivery.
• Physician intent plays a role in the effectiveness of reminder systems.