Physician perceptions of clinical reminders

Objective: To measure differences in physician perception of clinical decision reminders. Design: Residents and attending physicians in a VA General Medicine Clinic participated in the study. They were asked to rank order (Q-sort) 44 opinion statements from those most important, those about which they were ambivalent, to those most unimportant, answering the question: "Which issues would be important or not so important to you in affecting your behavior following the appearance of a computer-generated decision support alert?". Measurements: 21 Q-sorts were performed by 12 attending physicians (attendings) and 9 residents. The data were analyzed using PQ-Method 2.11 for statistical analysis. The output of analysis, the factors, represents groups who share an opinion set. Results: From the combined results, three factors (stories) emerged: A1, Medicine cannot be reduced to rules; A2, Alerts undermine patient and provider autonomy; and A3, Alerts raise issues of authority. When analyzing the residents' results alone, two factors emerged: B1, Information provided in a non-clinical way; and B2, Legal ramifications are unknown. Conclusion: Clearly, within and outside the VA, the goal is to understand the barriers to the effectiveness of clinical reminders. Among the many barriers surrounding use of alerts, participants identified alerts (p<0.01) that were inappropriate to context, reduced patient's contact time, that intruded on professional autonomy, and were presented in a non-clinical way. They also identified alert fatigue and the sense of big brother watching. Limitations: As a qualitative method, Q is not intended to describe all possible opinions, but uniquely tries to capture opinion sets.