Project 2. Physician-Level Variation in Medication Overrides of Computerized Decision Support

DW Bates speaking about Project 2

With the implementation of electronic health records and clinical decision support (CDS), we now have an untapped resource that was not previously available: logs that capture providers' responses to CDS relating to medication safety and efficiency. Understanding how clinicians respond to CDS is critical to achieving meaningful use of electronic health records(EHRs). Beginning in 2011, providers are being rewarded by the government for achieving “meaningful use“ of certified (EHR) systems however, simply purchasing a certified, fully functional EHR with CDS is not enough to achieve improvements in quality and patient safety. Key system functionality must be utilized in order to improve safety and quality, our prior work suggests that uptake of such functionality has been highly variable among adopters of EHRs.

We believe that we will be able to identify substantial variation by provider for a variety of dimensions, including safety and efficiency.

In this study, our specific aims are to:

Specific Aim 1. Evaluate how much clustering of overrides there is by provider for both safety and efficiency-related issues in the inpatient and outpatient settings.
Specific Aim 2. Evaluate the appropriateness of overrides overall and among those providers with high override rates.
Specific Aim 3. Characterize and understand the patterns and reasons for these override behaviors and decisions.
Specific Aim 4. Intervene with providers who have high override rates, for the specific categories that appear inappropriate.

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