Experience with decision support system and comfort with topic predict clinicians' responses to alerts and reminders

Nerissa S. Bauer, Aaron E. Carroll, Chandan Saha, Stephen M. Downs

Research output: Contribution to journalArticle

7 Scopus citations


Objective: Clinicians at our institution typically respond to about half of the prompts they are given by the clinic's computer decision support system (CDSS). We sought to examine factors associated with clinician response to CDSS prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. Methods: We examined patient, prompt, and clinician characteristics associated with clinician response to decision support prompts from the Child Health Improvement through Computer Automation (CHICA) system. We asked pediatricians who were nonusers of CHICA to rate decision support topics as "easy" or "not easy" to discuss with patients and their guardians. We analyzed these ratings and data, from July 1, 2009 to January 29, 2013, utilizing a hierarchical regression model, to determine whether factors such as comfort with the prompt topic and the length of the user's experience with CHICA contribute to user response rates. Results: We examined 414 653 prompts from 22 260 patients. The length of time a clinician had been using CHICA was associated with an increase in their prompt response rate. Clinicians were more likely to respond to topics rated as "easy" to discuss. The position of the prompt on the page, clinician gender, and the patient's age, race/ethnicity, and preferred language were also predictive of prompt response rate. Conclusion This study highlights several factors associated with clinician prompt response rates that could be generalized to other health information technology applications, including the clinician's length of exposure to the CDSS, the prompt's position on the page, and the clinician's comfort with the prompt topic. Incorporating continuous quality improvement efforts when designing and implementing health information technology may ensure that its use is optimized.

Original languageEnglish (US)
Pages (from-to)e125-e130
JournalJournal of the American Medical Informatics Association
Issue numbere1
StatePublished - Apr 1 2016


  • Clinical guidelines
  • Computer-based decision support
  • Pediatrics
  • Primary care

ASJC Scopus subject areas

  • Health Informatics

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