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Submitted on June 1, 2004
Accepted on February 16, 2005
Affiliation of the authors: 1 Department of Biomedical Informatics, School of Nursing and Department of Internal Medicine, Vanderbilt University, Nashville, TN; 2 Division of Medical Informatics, Geneva University Hospitals, Geneva, Switzerland; 3 Department of Biostatistics, Vanderbilt University, Nashville, TN; 4 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; 5 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN; Tennessee Technological University, Cookeville, TN; 6 Regenstrief Institute, Inc., Indiana University, Indianapolis, IN; 7 Department of Biomedical Informatics and Department of Internal Medicine, Vanderbilt University, Nashville, TN
* To whom correspondence should be addressed.
Objective Authors evaluated whether displaying context sensitive links to infrequently accessed educational materials and patient information via the user interface of an inpatient computerized care provider order entry (CPOE) system would affect access rates to the materials.
Design Vanderbilt University Hospital's (VUH) CPOE system included baseline clinical decision support advice for safety and quality. Authors augmented this with seven new primarily educational decision support features. A prospective, randomized controlled trial compared clinicians' utilization rates for the new materials via two interfaces. Control subjects could access study-related decision support from a menu in the standard CPOE interface. Intervention subjects received active notification when study-related decision support was available through context sensitive, visibly highlighted, selectable hyperlinks.
Measurements Rates of opportunities to access and utilization of study-related decision support materials from April 1999 through March 2000 on seven VUH Internal Medicine wards.
Results During 4,466 intervention subject-days there were 240,504 (53.9/subject-day) opportunities for study-related decision support, while during 3,397 control subject-days there were 178,235 (52.5/subject-day) opportunities for such decision support, respectively (P= 0.11). Individual intervention subjects accessed the decision support features at least once on 3.8% of subject-days-logged-on (278 responses); controls accessed it at least once on 0.6% of subject-days (18 responses), with a response rate ratio adjusted for decision support frequency of 9.17 (95% CI 4.6 - 18, P < 0.0005). On average, intervention subjects accessed study-related decision support materials once every 16 days individually and once every 1.26 days in aggregate.
Conclusion Highlighting availability of context-sensitive educational materials and patient information through visible hyperlinks significantly increased utilization rates for study-related decision support when compared to standard VUH CPOE methods, although absolute response rates were low.
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