Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

In Health Services Research, Alexander Fiks and colleagues, including Christopher Forrest, analyze the impact of feedback in improving adoption of clinical decision support (CDS). The work is part of a larger trial of the effectiveness of CDS for diagnosing and treating ear infections in children. While substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use CDS, the impact of feedback on clinician use of CDS systems has not been well studied. The authors looked at EHR-based CDS adoption during 41,391 ear infection visits, and compared clinicians receiving performance feedback to those receiving none. Their analysis finds that clinicians who received feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0% compared to others. However, clinicians and practices only used the CDS system for approximately 20% of eligible visits. The authors suggest that physician performance feedback represents a promising strategy to increase the salience of CDS, minimize alert fatigue, and maximize the benefits of CDS for quality.  But while performance feedback increased CDS adoption, additional incentives are needed to integrate the CDS into primary care workflows.