Computerized medical records and preventive health care: success depends on many factors

• HIT Description: Electronic health record and decision support with reminders. More info...
  
• Purpose of Study: Study the effect of a computerized medical record with reminders on the delivery of preventive health care.
  
• Years of study: 1985-1987
  
• Study Design: CCT
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: Forty-five internal medicine residents and their 4 supervising attending physicians at a university general internal medicine teaching clinic participated in the trial.
• Intervention: A study group using a computerized ambulatory medical record system that included health care maintenance reminders was compared to a control group using a conventional paper record with a health care maintenance flow sheet.
• Evaluation Method: Measures of preventive services.
• Quality of Care and Patient Safety Outcome: The computer reminders significantly increased health care maintenance recommendations made to patients for proctosigmoidoscopy, tetanus vaccination, influenza vaccination, and pneumococcal vaccination, but not for fecal occult blood testing, mammography, Pap smears, or serum thyroxine screening in the elderly. First-year residents were nearly twice as successful as third-year residents in overall health care maintenance. Success scores varied markedly depending on which attending physician was supervising the residents. A strong interaction was found among group assignment, supervising attending, and level of training such that the reminders doubled success scores among first-year residents supervised by two of the attending physicians but had little effect on other subgroups. The time of year and the format of the reminder also had important effects for some of the maneuvers.