David Chan, M.D., an assistant professor at Stanford School of Medicine, has received a National Institutes of Health Early Independence Award to study the impact of electronic health record clinical reminders on the quality of primary care. These reminders include a range of clinical messages for providers, from a simple prompt to write a prescription to more complex recommendations for follow-up testing and specialist referrals.
On the one hand, electronic reminders can present helpful information to support better patient care, says Chan, also a physician scientist at Veterans Affairs Palo Alto Health Care, in his research proposal. On the other hand, given the limits of human cognitive processing and attention, there is the distinct possibility that reminders may overburden clinicians with too much information. There is currently little empirical evidence weighing the benefits and burdens of increasing the informational content of systems of electronic reminders.
According to NIH Director Francis Collins, M.D., Chans research will focus on the Veterans Health Administration (VHA)the nations largest healthcare delivery system serving about 9 million enrollees at 150 hospitals and 819 community-based outpatient clinicswhich was among the first healthcare systems to adopt EHRs. Writing in a recent blog, Collins argues that the VHA will provide an excellent window into the real-world experiences of doctors, nurses, and other healthcare professionals accustomed to working with electronic reminders.
In fact, he discloses that preliminary research by Chan shows that, depending upon the VHA facility, the same type of healthcare provider caring for the same type of patient may have to process as few as 5 or as many as 40 electronic reminders relating to preventive care and disease management. However, as Collins points, one of the many questions that Chan is asking: Is 5 too few and 40 too many?
Chans research will delve deeper into how EHR clinical reminders vary not only in quantity, but in topic breadth, complexity, and comprehensibility, according to Collins. Most importantly, he says Chan will analyze the impact of all of these factors upon the productivity and efficiency of healthcare professionals and the quality of care received by patients.
The NIH Directors Early Independence Award is designed to support research for outstandingly talented early career researchers to move rapidly into independent research positions at U.S. institutions by essentially omitting the traditional post-doctoral training period.
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