PEARLS No. 209, October 2009, written by Brian R McAvoy

Clinical question

How effective are on-screen, point of care computer reminders on processes and outcomes of care?  

Bottom line

The review found small to moderate benefits. The reminders improved physician practices (process adherence, medication ordering, vaccinations and test ordering) by a median of 4%. In 8 of the studies, patients' health (reduction in blood pressure or serum cholesterol) improved by a median of 3%.  

Caveat

Although some studies showed larger benefits than these median effects, no specific reminders or features of how they worked were consistently associated with these larger benefits. More research is needed to identify what types of reminders work and when.  

Context

The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from email alerts, computer-generated paper reminders, and other modes of delivering "computer reminders".

Cochrane Systematic Review

Shojania KG et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Reviews 2009, Issue 3. Article No. CD001096. DOI: 10.1002/14651858. CD001096.pub2. This review contains 28 studies involving 126,099 participants.