Improving Clinical Quality Indicators Through Electronic Health Records: It Takes More Than Just a Reminder

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Abstract
State-of-the-art electronic health record systems with advanced clinical decision support (CDS) capabilities can fundamentally improve quality and reduce costs of health care.1,2 However, these outcomes have not been universally achieved.3,4 As the study by Fiks et al5 in this issue of Pediatrics demonstrates, providing CDS in the form of “alerts” to encourage desired health care activities may not be sufficient to make a substantial impact.6 Maximizing the potential of CDS for improving quality and safety of care requires attention to several factors, not all of which are related to the computer system.7 The goal for the study by Fiks et al was to increase vaccination rates in asthmatic children, so in examining the results one must first consider what caused the low vaccination rate in their population. Several factors could account for the low initial vaccination rates and, hence, could explain the minimal improvements with alerting. Without knowledge about these factors, it may be too much to expect alerts alone to fix the problem. Alerts are helpful when an unusual occurrence must come to a physician's attention or when a necessary … Address correspondence to Dean F. Sittig, PhD, University of Texas Health Sciences Center at Houston, School of Health Information Sciences, 6410 Fannin St, Houston, TX 77030. E-mail: dean.f.sittig{at}uth.tmc.edu

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