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Using computerized provider order entry and clinical decision support to improve referring physicians' implementation of consultants' medical recommendations – Source: Journal of the American Medical Informatics Association, Mar-Apr 2009

  [ 20 votes ]   [ Discuss This Article ]
By Martin C Were, MD, MS, et al. • • March 6, 2009

[To read the full text of this article free, including a description of the computerized provider order entry (CPOE) system used, click here.]

Objectives: Only half of consultants' [specialists’] medical recommendations are implemented.

We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.

Measurements: The tool was piloted among geriatrics consultants and hospitalists [physicians who work in the hospital]. Pre-post evaluation was done with control (before pilot; N = 20) and intervention (after pilot; N = 20) patients.

Consultants wrote notes containing recommendations for all study patients, and entered electronic recommendations only for intervention patients. We analyzed all recommendations and surveyed hospitalists.

A total of 249 recommendations were made for intervention patients versus 192 for controls (p < 0.05). Of all recommendations about intervention patients, 78% were implemented, compared to 59% for controls (p = 0.01).

Of the intervention recommendations, 77% were entered electronically using our tool; of these, 86% were implemented.

All 24 survey respondents indicated that the system:

• Improved quality,

• Saved time,

• And should be expanded.

Conclusion: Consultant recommendations were implemented 30% more often when there was electronic facilitation of recommendations.

Source: Journal of the American Medical Informatics Association, Mar-Apr 2009;16:196-202. DOI 10.1197/jamia.M2932, by Were MC, Abernathy G, Hui SL, Kempf C, Weiner M. Indiana University School of Medicine; Regenstrief Institute, Inc.; Roudebush VA Center of Excellence for Implementing Evidence Based Practice; Indiana University Center for Aging Research, Indianapolis, Indiana, USA. [E-mail:]

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