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Providers’ Reactions to an Automated Health Maintenance Reminder System Incorporated into the Patient’s Electronic Medical Record

From the Departments of Family Medicine (KGS, TEN), Epidemiology (TDK), and the Robert Wood Johnson Clinical Scholars Program (KGS, TDK), University of Washington, and the University of Washington Physicians Network (KGS, TEN), Seattle. Address reprint requests to Kenneth G. Schellhase, MD, MPH, Department of Family & Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226

Background: Automated health maintenance reminder (HMR) systems embedded in electronic medical records systems have been found to improve utilization of preventive services, but underuse persists. Our goal was to learn how to make HMRs more effective by measuring clinicians’ self-reported use of HMRs and attitudes toward an HMR system embedded in an electronic medical record.

Methods: We surveyed 43 clinicians using an electronic medical record with an automated HMR system that prompted the provision of preventive or screening interventions. We measured general attitudes toward computers and the HMR, attitudes toward health maintenance, reactions to key features of the HMR system, and use of information provided by the HMR system; and we asked open-ended responses on how to improve the system.

Results: Seventy-five percent of clinicians reported not observing or paying attention to the HMR flashing reminder icon when reviewing a chart, and 62.8% reported they either ignored or forgot to address an alert when it appeared. Only 20% reported regularly reviewing health maintenance needs of the patient before the clinical encounter, and 56% reported seldom or never acting on HMR information during an encounter that was not health maintenance.

Conclusions: This HMR system embedded in an electronic medical record was underused by clinicians, causing lost opportunities for provision of preventive care. As electronic medical records become more common, we need to find practical ways that are acceptable to clinicians to use the new capabilities the systems provide.