The objective of this study is to examine the impact of a clinical reminder generated by an electronic medical record (EMR) system on physician prescribing behavior in community oncology practice setting. A case-control trial assessing the prescribing rates of erythropoietin by physicians is used. The participants and setting involves a total of 11,644 physician-patient encounters in 2 community oncology practices in the United States during a 21-month period. The intervention is a clinical reminder generated in real time during a physician-patient encounter by an EMR identifying cancer patients with low hemoglobin (Hgb) levels (ie, anemic), that is, patients with Hgb less then 12 g/dL. The main outcome measure is to determine the frequency of erythropoietin prescription by physicians to cancer patients with low Hgb levels. Implementation of a clinical reminder generated by way of an EMR significantly improved the likelihood of low-Hgb patients receiving treatment with erythropoietin. Low-Hgb patients in the experimental clinic during the time that the clinical reminder system was in place were almost twice as likely (ie, adjusted odds ratio = 1.92, P = .008) to have been treated with erythropoietin. The data support the effectiveness of clinical reminders as a way to influence physician prescribing behaviors and potentially improve the quality of patient care. However, we feel that there is a need to investigate the use of reminders in other aspects of cancer care that may be undertreated or when new drugs may be available but are underused.
Adams WG, Man AM, Bauchner H. Use of an electronic medical record improves the quality of urban pediatric primary care. Pediatrics. 2003;111:626-632.
2.
Antman EM, Lau J, Kupelnick B, et al.A comparison of results of meta-analyses of randomized controlled trials and recommendations of clinical experts. J Am Med Assoc. 1992;268:240-248.
3.
Ashbury FD, Findlay H, Reynolds B, et al.A Canadian survey of cancer patients' experiences: are their needs being met?. J Pain Symptom Manage. 1998;16:298-306.
4.
Anderson DH, ed. Changing Physician Behavior Through Practice Guidelines. Santa Barbara: COR Healthcare Resources; 1996.
5.
Davis D, O'Brien MAT, Freemantle N, et al.Impact of formal continuing medical education. J Am Med Assoc. 1999;282:867-874.
6.
Dick RS, Steen EB, eds. The Computer-Based Patient Record:An Essential Technology for Health Care. 2nd ed.Washington, DC: National Academy Press; 1997.
7.
Englebardt SP, Nelson R. Health Care Informatics An Interdisciplinary Approach. St Louis: Mosby; 2002.
8.
European Secondary Prevention Study Group. Translation of clinical trials into practice: a European population-based study of the use of thrombolysis for acute myocardial infarction. Lancet. 1996;347:1203-1207.
9.
Fletcher RD, Dayhoff RE, Wu CM, et al.Computerized medical records in the Department of Veterans Affairs. Cancer. 2001; 91(suppl 8):1603-1606.
10.
Ford L, Kaluzny AD, Sondik E. Diffusion and adoption of state-of-the-art therapy. Semin Oncol. 1990;17:485-494.
HIMSS (Healthcare Information and Management Systems Society). Leadership survey, 2001. In: Englebardt SP, Nelson R, eds. Health Care Informatics: An Interdisciplinary Approach. St. Louis, Mo: Mosby; 2002:219.
13.
Goldberg H, Neighbor W, Cheadle A, et al.A controlled time-series trial of clinical reminders: using computerized firm systems to make quality improvement research a routine part of mainstream practice. Health Serv Res. 2000;34:1519-1534.
14.
Gordon MS. Managing anemia in the cancer patient: old problems, future solutions. Oncologist. 2002;7:331-341.
15.
Hunt D, Haynes R, Hanna S, et al.Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. J Am Med Assoc. 1998; 280:1339-1346.
16.
Lomas J, Haynes RB. A taxonomy and critical review of tested strategies for the application of clinical practice recommendations: from "official" to "individual' clinical policy. Am J Prev Med. 1988;4(suppl):77-94.
17.
Oxman AD, Thomson MA, Davis DA, et al.No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J1995;153:1423-1431.
18.
McGivney WT. The national comprehensive cancer network-present and future directions. Cancer. 1998;82(suppl):2057-2060.
19.
Quirt I, Robeson RC, Lau CY, et al.Epoetin alfa therapy increases hemoglobin levels and improves quality of life in patients with cancer-related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy. J Clin Oncol. 2001;19:4126-4134.
20.
Rosser W, Hutchinson BG, McDowell I, et al.Use of reminders to increase compliance with tetanus booster vaccination. Can Med Assoc J1992;146:911-917.
21.
Sawka C, Olivotto I, Coldman A, et al.The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer. British Columbia/Ontario Working Group. Br J Cancer. 1997;75:1534-1542.
22.
Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3:399-409.
23.
Shojania K, Yokoe D, Platt R, et al.Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc. 1998;5:554-562.
24.
Soignet S. Management of cancer-related amenia: epoetin alfa and quality of life [review]. Semin Hematol. 2000;37(suppl 6):9-13.
25.
Solberg LI, Kottke TE, Brekke ML, et al.Continuous quality improvement to increase preventive services in clinical practice-going beyond guidelines. Prey Med. 1996;25:259-267.
26.
StataCorp. STATA Statistical Software. Release 7.0. College Station, Tex: StataCorp; 2001.
27.
Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990;322:1499-1504.
28.
Tierney WM, McDonald CJ, Martin DK, et al.Computerized display of past test results. Ann Intern Med. 1987;107:569-574.
29.
Wenner A. Dances with data: why we don't have an electronic medical record. e.MD. 1996; 1:10-11.
