PT  - JOURNAL ARTICLE
AU  - Shojania, Kaveh G.
AU  - Jennings, Alison
AU  - Mayhew, Alain
AU  - Ramsay, Craig
AU  - Eccles, Martin
AU  - Grimshaw, Jeremy
TI  - Effect of point-of-care computer reminders on physician behaviour: a systematic review
AID  - 10.1503/cmaj.090578
DP  - 2010 Mar 23
TA  - Canadian Medical Association Journal
PG  - E216--E225
VI  - 182
IP  - 5
4099  - http://www.cmaj.ca/content/182/5/E216.short
4100  - http://www.cmaj.ca/content/182/5/E216.full
SO  - CMAJ2010 Mar 23; 182
AB  - Background: The opportunity to improve care using computer reminders is one of the main incentives for implementing sophisticated clinical information systems. We conducted a systematic review to quantify the expected magnitude of improvements in processes of care from computer reminders delivered to clinicians during their routine activities. Methods: We searched the MEDLINE, Embase and CINAHL databases (to July 2008) and scanned the bibliographies of retrieved articles. We included studies in our review if they used a randomized or quasi-randomized design to evaluate improvements in processes or outcomes of care from computer reminders delivered to physicians during routine electronic ordering or charting activities. Results: Among the 28 trials (reporting 32 comparisons) included in our study, we found that computer reminders improved adherence to processes of care by a median of 4.2% (interquartile range [IQR] 0.8%–18.8%). Using the best outcome from each study, we found that the median improvement was 5.6% (IQR 2.0%–19.2%). A minority of studies reported larger effects; however, no study characteristic or reminder feature significantly predicted the magnitude of effect except in one institution, where a well-developed, “homegrown” clinical information system achieved larger improvements than in all other studies (median 16.8% [IQR 8.7%–26.0%] v. 3.0% [IQR 0.5%–11.5%]; p = 0.04). A trend toward larger improvements was seen for reminders that required users to enter a response (median 12.9% [IQR 2.7%–22.8%] v. 2.7% [IQR 0.6%–5.6%]; p = 0.09). Interpretation: Computer reminders produced much smaller improvements than those generally expected from the implementation of computerized order entry and electronic medical record systems. Further research is required to identify features of reminder systems consistently associated with clinically worthwhile improvements.