Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations
- aIndiana University School of Medicine, Indianapolis, Indiana
- bRegenstrief Institute, Inc., Indianapolis, Indiana
- cRoudebush VA Center of Excellence for Implementing Evidence Based Practice, Indianapolis, Indiana
- dIndiana University Center for Aging Research, Indianapolis, Indiana
- Correspondence: Martin C. Were, MD, MS, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, Indiana 46202-3012; e-mail: <mwere{at}regenstrief.org>
- Received 17 July 2008
- Accepted 13 October 2008
Abstract
Objectives Only half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.
Measurements The tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N = 20) and intervention (after pilot; N = 20) patients. Consultants wrote notes containing recommendations for all study patients, and entered electronic recommendations only for intervention patients. We analyzed all recommendations and surveyed hospitalists.
Results A total of 249 recommendations were made for intervention patients versus 192 for controls (p < 0.05). Of all recommendations about intervention patients, 78% were implemented, compared to 59% for controls (p = 0.01). Of the intervention recommendations, 77% were entered electronically using our tool; of these, 86% were implemented. All 24 survey respondents indicated that the system improved quality, saved time, and should be expanded.
Conclusion Consultant recommendations were implemented 30% more often when there was electronic facilitation of recommendations.
Footnotes
-
Presented at the 2008 NLM Informatics Training Conference, July 8, 2008, Bethesda, Maryland.
-
This work was performed at Regenstrief Institute and Indiana University School of Medicine, Indianapolis, IN, and was supported by grant 5K23AG020088 from the National Institute on Aging and grant LM07117-11 from the National Library of Medicine.
