Electronic health records alone have not been shown to improve quality of care.
"What matters is how you use the electronic health records, so they make your job easier rather than act as a source of constant annoyance and false alarms," Persell said. "By showing only things that appear to be out of order, we are trying not to overwhelm the physician. If doctors get inaccurate alerts saying do this, do that, then they will ignore them."
Essential to the success of the program: it doesn't waste the doctor's time, is tied to performance reviews and isn't annoying.
"You can't shove it in doctors' faces, or they walk away from it," Persell noted. "We used reminders that were not intrusive, but were still effective because doctors had faith that the data was accurate and they could enter data to make it more accurate."
David Baker, M.D., senior author and chief of Northwestern Medicine's general internal medicine divison, added, "We wanted physicians to feel ownership of this. For this to work well, they have to view the alerts and reporting system as their personal quality improvement tools."
Doctors' interactions with the reminders were tied to quarterly performance reports based on their treatment of chronic disease and preventive care quality measures. They were willing to use the electronic tools, Persell believes, because they were regularly being reminded of their performance, and the tools were helping them improve it.
To create the program, researchers used existing tools already available in a commercial electronic health records system. They integrated the health records with performance reports and paid close attention to the quality of information fed to physicians.
When a recommended treatment is not
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