title: Variation in implementation and use of computerized clinical reminders in an integrated healthcare system.
abstract: OBJECTIVE
  To identify patterns of use of computerized clinical reminders (CCRs) across an integrated healthcare system and describe institutional factors associated with their implementation.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  At a national electronic health record (EHR) meeting, we surveyed 261 participants from 104 Veterans Health Administration (VHA) healthcare facilities regarding the number and types of CCRs available at each facility. Potential explanatory measures included perceived utility and ease of use of CCRs, training and personnel support for computer use, EHR functionalities, and performance data feedback to providers at each facility.
  
  
  RESULTS
  The number of conditions with CCRs in use at a facility ranged from 1 to 15; most reported implementation of reminders for 10 of the 15 conditions surveyed. The most commonly implemented CCRs, used in more than 85% of facilities, were for conditions with VHA national performance measures (eg, tobacco cessation, immunizations, diabetes mellitus). The least commonly implemented CCRs were for post-deployment health evaluation and management, medically unexplained symptoms, and erectile dysfunction. Facilities that had implemented greater numbers of clinical reminders had providers who reported greater ease of use and utility of the reminders (P= .01).
  
  
  CONCLUSIONS
  VHA facilities vary markedly in their implementation of CCRs. This effect may be partly explained by greater incorporation of clinical reminders for conditions with performance measures. Further study is needed to determine how to best implement clinical reminders and the institutional factors important in their use.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. cfung@mednet.ucla.edu
authors.forename: Constance H
authors.initials: CH
authors.lastname: Fung
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Woods
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Peter
authors.initials: P
authors.lastname: Glassman
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003200:Computer User Training; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004059:Diffusion of Innovation; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology; D017010:Reminder Systems / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs