Computer reminders help physicians less than hoped

A systematic review of 28 clinical trials published today concludes "implementing these expensive technologies will constitute an expensive exercise in trial and error."

Elizabeth Armstrong Moore
Elizabeth Armstrong Moore is based in Portland, Oregon, and has written for Wired, The Christian Science Monitor, and public radio. Her semi-obscure hobbies include climbing, billiards, board games that take up a lot of space, and piano.
Elizabeth Armstrong Moore

A systematic review of 28 clinical trials, which appears today in the Canadian Medical Association Journal, finds that computer reminders to physicians regarding prescriptions yield smaller improvements than expected.

The study shows that computer reminders sent to physicians during routine electronic ordering or charting improve process of care by a median of 4.2 percent, with the best outcome showing a median improvement of 5.6 percent--numbers that are "below thresholds for clinically significant improvements," writes Dr. Kaveh G. Shojania, director of the University of Toronto's Centre for Patient Safety.

The authors conclude that further research should be conducted before adopting computer reminders:

Until further research identifies study design and reminder features that reliably predict clinically worthwhile improvements in care, implementing these expensive technologies will constitute an expensive exercise in trial and error.

It should be noted, however, that computer reminders almost never resulted in worse outcomes. And as an aside, two weeks ago we reported that prescriptions written by hand are seven times more likely to result in errors than e-prescriptions.

All of this is to say that it might not not necessarily be the concept of computer reminders that should be reconsidered, but rather how such reminders are designed.