Clinical Reminders: Explaining Variability in Adoption by Nurses and Physicians at Four Outpatient Clinics

Abstract

Computerized clinical reminders (CRs) can improve compliance with evidence-based practices in preventive care and chronic disease management. However, observational research is needed to explain the known variability in the use of CRs. We conducted ethnographic observations of nurses and providers using CRs in outpatient primary care clinics for two days in each of four geographically distributed Veterans Administration (VA) medical centers. We found that use of CRs was impeded by (1) lack of coordination between nurses and providers, (2) using the reminders while not with the patient, impairing data acquisition and/or implementation of recommended actions, (3) workload, (4) lack of CR flexibility, and (5) poor interface usability. We discuss implications of these findings for CR system design and provide recommendations for redesign to facilitate the effective use of CRs.

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References

Demakis

J. G.

Beauchamp

Cull

W.L.

Denwood

Eisen

S. A.

Lofgren

(2000). Improving residents' compliance with standards of ambulatory care: Results from the VA cooperative study on computerized reminders JAMA, 284(11), 1411–1416.

Hollnagel

Pedersen

O. M.

Rasmussen

(1981). Notes on human performance analysis. (Riso-M-2285). Roskilde, Denmark: Riso National Laboratory.

Hutchins

Cognition in the Wild. Cambridge, MA: MIT Press, 1995.

McGlynn

E. A.

Asch

S. M.

Adams

Keesey

Hicks

DeCristofaro

(2003). The quality of health care delivered to adults in the United States N Engl J Med, 348(26), 2635–2645.

Militello

Patterson

E. S.

Tripp-Reimer

Asch

S. M.

Fung

C. H.

Glassman (2004). Clinical reminders: Why don't they use them? Proceedings of the Human Factors and Ergonomics Society 48th Annual Meeting (pp. 1651–1655). Santa Monica, CA: Human Factors and Ergonomics Society.

Patterson

E. S.

Cook

R. I.

Render

M. L.

(2002). Improving patient safety by identifying side effects from introducing bar coding in medication administration J Am Med Inform Assoc, 9, 540–53.

Patterson

E. S.

Nguyen

A. D.

Halloran

J. P.

Asch

S. M.

(2004). Human factors barriers to the effective use of ten HIV clinical reminders J Am Med Inform Assoc, 11, 50–59.

Saleem

J. J.

Patterson

E. S.

Militello

Render

M. L.

Orshansky

Asch

S. A.

(In Press). Exploring barriers and facilitators to the use of computerized clinical reminders. J Am Med Inform Assoc, 12(4).

Shea

DuMouchel

Bahamonde

(1996). A meta-analysis of 16 randomized controlled clinical trials to evaluate computerbased clinical reminders systems for preventive care in the ambulatory setting J Am Med Inform Assoc, 3, 399–409.

10.

Xiao

Vicente

K. J.

(2000). A framework for epistemological analysis in empirical (laboratory and field) studies Human Factors, 42, 87–101.