Clinical Reminders Designed and Implemented Using Cognitive and Organizational Science Principles Decrease Reminder Fatigue

Abstract

Background:Response rates to point-of-care clinical reminders typically decrease over time. We hypothesized that this "reminder fatigue" could be prevented by (1) applying sound human factors engineering and cognitive science principles in designing the reminder system, and (2) implementing the reminders with rigorous attention to organizational science principles.Methods: This was a retrospective cohort enumeration from January 1, 2006, through July 31, 2012, in a set of 5 academically affiliated family medicine practices. We modeled the odds ratio of clinician action in response to a reminder according to the number of reminders issued during the encounter, the number of problems on the patient's problem list, patient age, and time (number of months since launch) using logistic regression with clustering by encounter.Results: There were issued 988,149 reminders at 453,537 encounters during the sampling frame. Action was taken in response to 60.1% of reminders, and discussion or consideration was documented in another 26.8%. The odds ratios for action in response to reminders over time, by number of prompts during the encounter, and by number of problems were 1.01, 1.18, and 1.02, respectively. Key design features included issuing reminders only when a service was due, allowing clinicians to attend to reminders when doing so fit their workflow (vs forcing attention at a specific time), keeping reminders very short and simple (action item only, no explicative material), and a team meeting and buy-in process before each new reminder was implemented.

Effects of multicomponent primary care-based intervention on immunization rates and missed opportunities to vaccinate adults

“…Our study corroborates previous reports that provider reminders remain the most effective way to increase vaccination rates at the provider level [13]. Studies exploring impact of CDS in general practice, however, indicate substantial levels of provider "alert fatigue," and future studies need to explore ways to keep providers engaged in continuous vaccination improvement efforts [14,15]. Additionally, in order for the CDS systems to be most effective, they have to rely on accurate evidence-based clinical algorithms that need to be regularly updated and aligned among multiple systems, settings, and patient populations.…”

Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives

“…They are feeling overwhelmed by clinical tasks, including responding to EHR clinical reminders [33], and may not have the capacity to add more to their clinical encounters.…”

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

“…For example, clinicians may perceive that screening instruments or clinical reminders like the HSCR do not apply to patients 25 and may experience a phenomenon known as "reminder fatigue" wherein an increasing number of clinical reminders for providers to complete leads to decreasing adherence to intended screening protocols. 26 With respect to the second set of challenges, taking action on information about housing instability and other social factors requires that this information is readily available to health care team members when they are making decisions about how to tailor care, referrals, and follow-up to patient needs. 22 Acting on information about housing instability also requires knowledge about what resources are available to address needs and how to connect people with those resources.…”