Using computerized provider order entry and clinical decision support to improve referring physicians' implementation of consultants' medical recommendations

J Am Med Inform Assoc. 2009 Mar-Apr;16(2):196-202. doi: 10.1197/jamia.M2932. Epub 2008 Oct 24.


Objectives: Only half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.

Measurements: The tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N=20) and intervention (after pilot; N=20) patients. Consultants wrote notes containing recommendations for all study patients, and entered electronic recommendations only for intervention patients. We analyzed all recommendations and surveyed hospitalists.

Results: A total of 249 recommendations were made for intervention patients versus 192 for controls (p<0.05). Of all recommendations about intervention patients, 78% were implemented, compared to 59% for controls (p=0.01). Of the intervention recommendations, 77% were entered electronically using our tool; of these, 86% were implemented. All 24 survey respondents indicated that the system improved quality, saved time, and should be expanded.

Conclusion: Consultant recommendations were implemented 30% more often when there was electronic facilitation of recommendations.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Medical Centers
  • Attitude of Health Personnel
  • Consultants*
  • Decision Support Systems, Clinical*
  • Geriatrics
  • Hospitalists
  • Hospitals, Urban
  • Humans
  • Medical Order Entry Systems*
  • Midwestern United States
  • Pilot Projects
  • Practice Patterns, Physicians'
  • Referral and Consultation
  • User-Computer Interface