Physicians ignore decision support alerts

Although decision support alerts may help to reduce errors and improve efficiency, many physicians choose to ignore them, according to a study conducted at the University of Illinois in Chicago.

The installation of a decision support system won't solve quality-of-care problems if physicians don't use it, said Annette L. Valenta, Dr.PH, an associate professor at the University of Illinois School of Biomedical and Health Information Sciences.

Valenta presented the results of her study during an electronic session at the HIMSS 2005 annual meeting in Dallas.

Citing a 1998 study by Bouaud, et al, Valenta noted that although 95% of physicians agreed with decision support system recommendations, they followed only 65% of the recommendations.

To determine the reasons behind this reluctance to comply with the systems' suggestions, Valenta and colleagues used both qualitative and quantitative methods to study a group of volunteer participants at their facility:

• 17 interns

• 26 residents

• 17 attendings

• 23other health professionals

The study documented four distinct attitudes among the volunteers regarding their hesitancy to rely on decision support alerts.

The first attitude was expressed in a "too busy for the value" statement. These physicians reported insufficient value for the additional effort required to use a decision support system.

The second attitude, embodied by the expression "show me the proof," represented physicians who were reluctant to follow the alerts because of uncertainty about the robustness of the alert. This group also reported that the alerts did not address the complexity of a given medical situation.

The third group just "did not like computers." These physicians described a reluctance to incorporate computer assistance into their clinical decision-making process. They indicated that the onscreen alerts were not as easy to assimilate as written or spoken communications.

The fourth group characterized themselves as "hands-on healers." They considered these computer systems a threat to their authority as physicians and claimed that they interfered with the physician/patient relationship. This group said that the alerts reduced the art of medicine and expressed fears of being replaced by a machine.

The survey allowed the researchers not only to identify the factors behind physicians' reluctance to comply with decision support alerts but also to seek remedies to these concerns.

Valenta suggested interventions such as improving the design of alerts to increase information access, providing information to physicians about the authors and background for alerts, demonstrating the utility of the alerts, and improving physician training and orientation for EMR use.