Background: 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.
Diverse stakeholders--clinicians, researchers, business leaders, policy makers, and the public--have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.
This study measured the impact of an electronic Panel Support Tool (PST) on primary care teams' performance on preventive, monitoring, and therapeutic evidence-based recommendations. The PST, tightly integrated with a comprehensive electronic health record, is a dynamic report that identifies gaps in 32 evidence-based care recommendations for individual patients, groups of patients selected by a provider, or all patients on a primary care provider's panel. It combines point-of-care recommendations, disease registry capabilities, and continuous performance feedback for providers.A serial cross-sectional study of the PST's impact on care performance was conducted, retrospectively using monthly summary data for 207 teams caring for 263,509 adult members in Kaiser Permanente's Northwest region. Baseline care performance was assessed 3 months before first PST use and at 4-month intervals over 20 months of follow-up. The main outcome measure was a monthly care performance percentage for each provider, calculated as the number of selected care recommendations that were completed for all patients divided by the number of clinical indications for care recommendations among them. Statistical analysis was performed using the t test and multiple regression. Average baseline care performance on the 13 measures was 72.9% (95% confidence interval [CI], 71.8%-74.0%). During the first 12 months of tool use, performance improved to a statistically significant degree every 4 months. After 20 months of follow-up, it increased to an average of 80.0% (95% CI, 79.3%-80.7%).
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