Paper previsit reminders for doctors do not add value to electronic reminders from an electronic health record system
Physicians who are lax in following up on electronic health record (EHR) point-of-care reminders about recommended care for patients with chronic diseases generally fail to respond to previsit paper reminders, according to a new study.
In an earlier phase of the study, the researchers found that including automatic electronic reminders to doctors significantly improved adherence to 14 of 16 quality-of-care measures, such as reduction in low-density lipoprotein levels for patients with diabetes. However, they found a subset of physicians whose performance had not improved to the same degree.
The second phase of the study tested whether giving clinicians printed lists of quality gaps in a patient's care at the time of the patient's visit would improve the quality of care beyond electronic reminders alone. They found that for all 31 physicians who participated in the study from its beginning, 8 of 15 quality measures improved significantly during phase 2, as they had during phase 1. However, performance for four of the measures that improved during phase 1 declined during phase 2. The median performance on all measures was 94.2 percent at the end of phase 1 and 95.6 percent at the end of phase 2.
Of the eight physicians with the lowest performance at the end of phase 1, six remained among the bottom eight clinicians at the end of phase 2. Adding the paper reminder—given to the physician just before he or she entered the examining room—did not improve the performance of these low-performing physicians. The study involved patients seen by physicians at an academic internal medicine practice in Chicago from February 1, 2007, through February 1, 2010. Phase 1 (using EHR-based electronic reminders) began on February 1, 2008, and ended on February 1, 2009, at which time phase 2 (using both electronic and paper reminders) began. The study was funded in part by the Agency for Healthcare Research and Quality (HS17163 and HS15647).
More details are in "The marginal value of pre-visit paper reminders when added to a multifaceted electronic health record based quality improvement system," by David W. Baker, M.D., M.P.H., Stephen D. Persell, M.D., M.P.H., Abel N. Kho, M.D., and others in the November/December 2011 Journal of the American Informatics Association 18(6), pp. 805-811.
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