Downs Stephen M, Anand Vibha, Dugan Tammy M, Carroll Aaron E
Children's Health Services Research, Indiana University, Indianapolis, IN;
AMIA Annu Symp Proc. 2010 Nov 13;2010:167-71.
Meaningful use of health information technology (HIT) requires the use of clinical decision support systems (CDSS). However, the effectiveness of CDSS depends on physician compliance with clinical reminders which is known to be highly variable. Our objective was to evaluate physician adherence to clinical reminders from a CDSS designed to maximize features known to improve practice.
We evaluated physicians' compliance with clinical reminders generated by the Child Health Improvement through Computer Automation (CHICA) system, a pediatric CDSS that generates scannable paper forms that are completed by patients, staff and physicians during routine care. The forms provide tailored reminders and collect coded clinical data during routine care. We examined CHICA's database to assess the rates of response by patients and physicians to questions and reminders generated by the system. Results showed that while patients answered, on average, 60.6% of 1,351,896 questions generated by the system over 5 years, physicians responded to only 42.9% of 343,949 alerts and reminders over the same period of time. Response rates appeared to be inversely related to both the complexity and sensitivity of the topic.
Poor physician adherence to clinical reminders in this optimized system reduces effectiveness of the system and poses some liability issues. Strategies to alert physicians to the reminders of highest import are needed.
有效利用健康信息技术（HIT）需要使用临床决策支持系统（CDSS）。然而，CDSS的有效性取决于医生对临床提醒的依从性，而众所周知这种依从性差异很大。我们的目标是评估医生对一个旨在最大化已知可改善医疗实践的功能的CDSS所发出的临床提醒的依从情况。
我们评估了医生对通过计算机自动化改善儿童健康（CHICA）系统生成的临床提醒的依从性，CHICA是一个儿科CDSS，它生成可扫描的纸质表格，供患者、工作人员和医生在常规护理期间填写。这些表格提供定制的提醒，并在常规护理期间收集编码的临床数据。我们检查了CHICA的数据库，以评估患者和医生对系统生成的问题和提醒的回复率。结果显示，在5年时间里，患者平均回答了系统生成的1351896个问题中的60.6%，而医生在同一时期仅对343949个警报和提醒中的42.9%做出了回应。回复率似乎与主题的复杂性和敏感性呈负相关。
在这个优化系统中，医生对临床提醒的依从性差降低了系统的有效性，并带来了一些责任问题。需要采取策略提醒医生注意最重要的提醒。
