An evaluation of the Veterans Health Administration's clinical reminders system: a national survey of generalists

Fung CH, Tsai JS, Lulejian A, Glassman P, Patterson E, Doebbeling BN, Asch SM. An evaluation of the Veterans Health Administration's clinical reminders system: a national survey of generalists. Journal of general internal medicine. 2008 Apr 1; 23(4):392-8.

Related HSR&D Project(s)

• TRX 02-216 – Human Factors and the Effectiveness of Computerized Clinical Reminders

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Abstract:

BACKGROUND: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians'' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA. OBJECTIVE: Survey PCPs about usefulness and usability of VHA CCRs. DESIGN AND PARTICIPANTS: In a national survey, VHA PCPs rated on a 7-point scale usefulness and usability of VHA CCRs, and standardized scales (0-100) were constructed. A hierarchical linear mixed (HLM) model predicted physician- and facility-level variables associated with more positive global assessment of CCRs. RESULTS: Four hundred sixty-one PCPs participated (response rate, 69%). Scale Cronbach''s alpha ranged from 0.62 to 0.82. Perceptions of VHA CCRs were primarily in the midrange, where higher ratings indicate more favorable attitudes (weighted standardized median, IQR): global assessment (50, 28-61), clinical/situational specificity (29, 17-42), integration with workflow/workload (39, 17-50), training (50, 33-67), VHA''s management of CCR use (67, 50-83), design/interface (53, 40-67), perceived role in CCR use (67, 50-83), and self-efficacy (67, 57-78). In a HLM model, design/interface (p < .001), self-efficacy (p < .001), integration with workflow/workload (p < .001), and training (p < .001) were associated with more favorable global assessments of CCRs. Facilities in the west as compared to the south (p = .033), and physicians with academic affiliation (p = .045) had less favorable global assessment of CCRs. CONCLUSIONS: Our systematic assessment of end-users'' perceptions of VHA CCRs suggests that CCRs need to be developed and implemented with a continual focus on improvement based on end-user feedback. Potential target areas include better integration into the primary care clinic workflow/workload.