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Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

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OBJECTIVE: Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence.

STUDY SETTING: A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010.

STUDY DESIGN: Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary.

DATA COLLECTION: Extraction from a common EHR.

PRINCIPAL FINDINGS: Clinicians and practices used the CDS system for a mean of 21 percent (range: 0–85 percent) and 17 percent (0–51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study.

CONCLUSIONS: Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.


Fiks A, Zhang P, Localio R, Khan S, Grundmeier R, Karavite D, Bailey C, Alessandrini E, Forrest C