2010. Variation in Implementation of Computerized Clinical Reminders in the VHA
Constance H Fung, MD, MSHS, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, JN Woods, The University of Iowa, SM Asch,
VA Center for the Study of Healthcare Provider Behavior and David Geffen School of Medicine at UCLA, P Glassman,
VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, BN Doebbeling,
Roudebush VAMC and Indiana University School of Medicine and Regenstrief Institute
Objectives: To identify patterns of adoption and implementation of computerized clinical reminders (CCRs) across the Veterans Health Administration (VHA) and describe facilitating factors and barriers.
Methods: We conducted a cross sectional survey of 261 participants representing 104 VHA facilities at a national Camp CPRS meeting. Main outcome measures: number and types of CCRs available at each facility. Other measures included: ease of use and usefulness of CCRs, training and personnel support for computer use, functionalities of electronic medical record, and availability of performance data feedback to providers.
Results: The number of CCRs in use ranged from one to fifteen; most facilities reported implementation of ten of the fifteen reminders surveyed. The most common CCRs, used in over 85% of facilities, were for those with VHA national performance measures (e.g., tobacco use cessation and immunizations). The least common CCRs were for post-deployment health evaluation/management and medically unexplained symptoms. Providers at facilities with a higher number of clinical reminders reported greater ease of use and usefulness of the reminders (Beta = 0.20, p=0.01).
Conclusions: VHA facilities have varying degrees of adoption and implementation of CCRs. This effect may be partly explained by incorporation of clinical reminders as performance measures and differences in perceived ease of use and usefulness of CCRs at certain facilities.
Impact: Our results suggest that greater attention to complexity and compatibility of CCRs, which hold promise as a technology for improving quality of care, may be important as the VHA promotes the adoption and implementation of CCR technology.