A survey of factors affecting clinician acceptance of clinical decision support

Department of Medical Informatics, Northwest Permanente PC, Portland, OR, USA.
BMC Medical Informatics and Decision Making (Impact Factor: 1.5). 02/2006; 6:6. DOI: 10.1186/1472-6947-6-6
Source: PubMed

ABSTRACT Real-time clinical decision support (CDS) integrated into clinicians' workflow has the potential to profoundly affect the cost, quality, and safety of health care delivery. Recent reports have identified a surprisingly low acceptance rate for different types of CDS. We hypothesized that factors affecting CDS system acceptance could be categorized as relating to differences in patients, physicians, CDS-type, or environmental characteristics.
We conducted a survey of all adult primary care physicians (PCPs, n = 225) within our group model Health Maintenance Organization (HMO) to identify factors that affect their acceptance of CDS. We defined clinical decision support broadly as "clinical information" that is either provided to you or accessible by you, from the clinical workstation (e.g., enhanced flow sheet displays, health maintenance reminders, alternative medication suggestions, order sets, alerts, and access to any internet-based information resources).
110 surveys were returned (49%). There were no differences in the age, gender, or years of service between those who returned the survey and the entire adult PCP population. Overall, clinicians stated that the CDS provided "helps them take better care of their patients" (3.6 on scale of 1:Never-5:Always), "is worth the time it takes" (3.5), and "reminds them of something they've forgotten" (3.2). There was no difference in the perceived acceptance rate of alerts based on their type (i.e., cost, safety, health maintenance). When asked about specific patient characteristics that would make the clinicians "more", "equally" or "less" likely to accept alerts: 41% stated that they were more (8% stated "less") likely to accept alerts on elderly patients (> 65 yrs); 38% were more (14% stated less) likely to accept alerts on patients with more than 5 current medications; and 38% were more (20% stated less) likely to accept alerts on patients with more than 5 chronic clinical conditions. Interestingly, 80% said they were less likely to accept alerts when they were behind schedule and 84% of clinicians admitted to being at least 20 minutes behind schedule "some", "most", or "all of the time".
Even though a majority of our clinical decision support suggestions are not explicitly followed, clinicians feel they are of benefit and would be even more beneficial if they had more time available to address them.

Download full-text


Available from: Dean Sittig, Jun 29, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As the complexity and amount of medical information keeps increasing, it is difficult to maintain the same quality of care. Therefore, clinical guidelines are used to structure best practices and care, but they also support physicians and nurses in the diagnostic and treatment process. Currently, no standardized format exists to represent these guidelines. Translating guidelines into a computer interpretable format can overcome problems in the physicians' workflow and improve clinician's uptake. An engine is proposed to automatically translate and execute clinical guidelines. These guidelines are represented as flowcharts, expressed in either (i) a computer interpretable guideline format or (ii) a UML diagram. A detailed overview of the architecture is presented and algorithms, aiming at grouping several components and distributing the guidelines, are proposed to optimize the execution of the guidelines. The Modified Schofield guideline for the calculation of the calorie need for burn patients was used for evaluation. Results show that the execution of guidelines using the engine is very efficient. Using optimization algorithms the execution times can be lowered.
    Computers in Biology and Medicine 07/2012; 42(8):793-805. DOI:10.1016/j.compbiomed.2012.06.003 · 1.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Decision-support systems, and specifically rule-based clinical reminders, are becoming common in medical practice. Despite their potential to improve clinical outcomes, physicians do not always use information from these systems. Concepts from the cognitive engineering literature on users' responses to warning systems may help to define physicians' responses to reminders. Based on this literature, we suggest an exhaustive set of possible responses to clinical reminders, consisting of four responses named "Compliance", "Reliance", "Spillover" and "Reactance". We suggest statistical measures to estimate these responses and empirically demonstrate them on data from a large-scale clinical reminder system for secondary prevention of cardiovascular diseases. There was evidence for Compliance, probably since the physicians found the reminders informative, but not for Reliance, in line with the notion that Compliance and Reliance are two distinct types of trust in information from decision-support systems. Our research supports the notion that CDSS can promote closing the treatment gap and improve physicians' adherence to guidelines.
    Journal of Biomedical Informatics 11/2008; 42(2):317-26. DOI:10.1016/j.jbi.2008.10.001 · 2.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is evidence that patients are being prescribed a significant number of duplicated prescriptions despite the use of computerized safety reminder systems. Nonetheless, the physicians' behavior with respect to the computer reminders has not been well studied as yet. This problem is important because drug duplication can result in patient overdose with unpredictable or undesirable effects; furthermore, it is also a waste of significant healthcare resources. In 2005, a computerized drug-duplication reminder system on the computerized physician order entry (CPOE) was implemented at a 737-bed teaching hospital in northern Taiwan. The log file, combined with the physicians' profiles, was statistically examined using the Mantel-Haenszel technique over the second half of 2005. A total of 11,298 orders (1.26%) involved drug-duplication reminders and this was out of 896,131 orders in 188,182 order set during the study period. The physicians related variables (workload, department, educational background, years in practice at the target hospital and age), policy related variables (intervention from the insurer and hospital administration), the order itself (drug price and medication class) and patients' resistance were found to be most critically related to physicians' behaviors in terms of the reminders. Intervention by Taiwan's National Insurance reimbursement policy appeared to be ineffective as a way of affecting the physicians' behavior. The log file appears to be a valuable source for analyzing physicians' behavior on reminders if well designed with the CPOE. Hospitals, clinicians and patients should pay more attention and be seriously concerned about CPOE reminders. It is also important to reexamine the physicians' workload and the insurer reimbursement policy in relation to drug duplication.
    International Journal of Medical Informatics 09/2008; 77(8):499-506. DOI:10.1016/j.ijmedinf.2007.10.002 · 2.72 Impact Factor