Computer reminders produce smaller-than-expected improvements

Computer reminders to physicians regarding prescribing produce much smaller improvements than initially expected, found a study in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj090578.pdf

Computerized systems for entering orders and electronic medical records are the two most widely recommended improvements in health care. These systems offer the opportunity to improve practice by delivering reminders, such as prescribing alerts, to clinicians caring for patients.

The study, a systematic review of 28 clinical trials, was conducted to measure the expected improvements in patient care with the help of computer reminders sent to physicians during their routine electronic ordering or charting activities. It found that computer reminders improved processes of care by a median of 4.2%, with the best outcome showing a median improvement of only 5.6%.

"Computer reminders typically increased adherence to target processes of care by amounts below thresholds for clinically significant improvements," write Dr. Kaveh G. Shojania, University of Toronto and coauthors. "A minority of studies showed more substantial improvements, consistent with the expectations of those who advocate widespread adoption of computerized order entry and electronic medical systems."

The authors conclude that until further research identifies improved design and reminder features that lead to worthwhile improvements in care, "implementing these costly technologies will be an expensive exercise in trial and error."