An evaluation of the Veterans Health Administration's clinical reminders system: a national survey of generalists

J Gen Intern Med. 2008 Apr;23(4):392-8. doi: 10.1007/s11606-007-0417-8.


Background: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA.

Objective: Survey PCPs about usefulness and usability of VHA CCRs.

Design and participants: In a national survey, VHA PCPs rated on a 7-point scale usefulness and usability of VHA CCRs, and standardized scales (0-100) were constructed. A hierarchical linear mixed (HLM) model predicted physician- and facility-level variables associated with more positive global assessment of CCRs.

Results: Four hundred sixty-one PCPs participated (response rate, 69%). Scale Cronbach's alpha ranged from 0.62 to 0.82. Perceptions of VHA CCRs were primarily in the midrange, where higher ratings indicate more favorable attitudes (weighted standardized median, IQR): global assessment (50, 28-61), clinical/situational specificity (29, 17-42), integration with workflow/workload (39, 17-50), training (50, 33-67), VHA's management of CCR use (67, 50-83), design/interface (53, 40-67), perceived role in CCR use (67, 50-83), and self-efficacy (67, 57-78). In a HLM model, design/interface (p < .001), self-efficacy (p < .001), integration with workflow/workload (p < .001), and training (p < .001) were associated with more favorable global assessments of CCRs. Facilities in the west as compared to the south (p = .033), and physicians with academic affiliation (p = .045) had less favorable global assessment of CCRs.

Conclusions: Our systematic assessment of end-users' perceptions of VHA CCRs suggests that CCRs need to be developed and implemented with a continual focus on improvement based on end-user feedback. Potential target areas include better integration into the primary care clinic workflow/workload.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Attitude to Computers*
  • Data Collection
  • Decision Support Systems, Clinical*
  • Female
  • Hospitals, Veterans*
  • Humans
  • Male
  • Medical Records Systems, Computerized*
  • Physicians, Family
  • Primary Health Care
  • Reminder Systems*
  • United States
  • United States Department of Veterans Affairs