Abstract
Background/Aims With the increasing adoption of electronic medical records (EMR), there are many opportunities to implement systems of information flow, like alerts to providers. Tests of such systems have varied results.
Methods Within a multispecialty group practice that uses Epic EMR, we conducted a trial of automated alerts to primary care physicians and their staff when older patients were discharged from hospital to home. We generated alerts for new medications, drug interactions, dose problems, or monitoring needs. Provider staff received alerts to schedule an office visit. Alerts appeared in the recipient’s Epic in-basket. Using EMR “digital crumbs”, we tracked the length of time before alerts were viewed. We analyzed the impact of physician age, gender, department, and employment status (full-time, part-time). We also analyzed the impact of patient conditions, including age, gender, comorbidity, and number of office visits in the previous year.
Results Of 763 alerts to physicians, 616 (81%) were opened within one day. Characteristics associated with timely opening were age <50 (OR 1.7, 95% CI 1.1, 2.6) and full-time employment (OR 2.9, 95% CI 1.6, 5.2). Of 1928 alerts to staff, 1173 (61%) were opened within one day. Physician characteristics associated with staff opening of alerts were gender (staff of male physicians were more likely to open the alerts within one day [OR 1.8, 95% CI 1.4, 2.4]), and being a member of the Family Medicine department (OR 1.9, 95% CI 1.3, 2.6) or sub-specialty department (OR 16.6, 95% CI 2.3, 122.3). Staff of full-time physicians were less likely to open alerts within one day (OR 0.64, 95% CI 0.47, 0.87). Controlling for patient characteristics had no impact on results.
Conclusions Special efforts may be required to reach physicians working part-time and older physicians. The characteristics related to staff opening of alerts are specific to this group practice, but the high level of variability across physician types and departments is likely to be an issue in many settings. Design of a system directed at reaching staff quickly may require in-depth assessment of work flow and communication patterns in clinical departments.
