Decision support intervention prompts clinicians to update patients' problem lists in their medical records

Research Activities, April 2011, No. 368

Every patient's medical record contains what is known as a "problem list," where everything the patient suffers from is listed. Both paper and electronic medical records require the constant updating of this list. However, physicians may be slow to keep this documentation current. A new study has looked at how physician order entry and decision support in electronic medical records (EMRs) can help keep the problem list current and complete. It found that alerts issued during medication order entry prompted physicians to add accurate diagnoses to the list.

Physicians at a 450-bed teaching hospital used an EMR that included clinical decision support and computerized physician order entry. Any time a physician entered an order for a study medication, a pop-up screen alert would appear, prompting the physician to enter one or more diagnoses for each medication ordered. The physician could also cancel or ignore the alert. Alerts were designed around six target diagnosis groups containing related diagnoses and their medication triggers. Each alert that was created for the system was studied for a 2-month period after being available for physicians to use.

A total of 1,011 alerts appeared for the 6 target diagnosis groups. The most alerts popped up for the diagnosis group consisting of high cholesterol and coronary artery disease. Diabetes came in second. When alerts did appear, additions to the problem list were made 76 percent of the time, with an accuracy rate of 95 percent. Both the HIV and diabetes diagnostic groups had 100 percent accurate problem list additions. According to the researchers, additional work is needed to expand the system in order to include more medications and all variations of clinician order entry. The study was supported in part by the Agency for Healthcare Research and Quality (HS16973).

See "Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance," by William L. Galanter, M.D., Ph.D., Daniel B. Hier, M.D., M.B.A., Chiang Jao, Ph.D., and David Sarne, M.D., in the International Journal of Medical Informatics 79, 332-338, 2010.

Current as of April 2011
Internet Citation: Decision support intervention prompts clinicians to update patients' problem lists in their medical records: Research Activities, April 2011, No. 368. April 2011. Agency for Healthcare Research and Quality, Rockville, MD.