EHR Nudges and Primary Care Outcomes

TOPLINE:

Electronic health record (EHR) nudges were linked to improved documentation and patient-centeredness in primary care. However, their impact on other healthcare quality measures and patient outcomes was less consistent.

METHODOLOGY:

• Researchers performed an electronic search on June 9, 2023, in PubMed, Embase, PsycINFO, CINAHL, and Web of Science for articles about clinician-facing EHR nudges.
• A total of 54 randomized clinical trials (RCTs) were included, focusing on primary care settings and evaluating the association between EHR nudges and health care quality and patient outcomes.
• The studies were scored from 0 to 5 points using the Risk of Bias 2.0 tool, with higher scores indicating a lower risk for bias.
• Most studies (79.6%) were assessed to have a moderate risk for bias, and the evaluation period varied across studies.
• The review included studies from various countries, with most located in the United States (79.6%), and used different study designs such as cluster, parallel, and crossover RCTs.

TAKEAWAY:

• EHR nudges were associated with improvements in documentation patterns, with 78.9% of descriptive measures showing positive associations (P < .05).
• Patient-centeredness measures, such as counseling rates for exercise, diet, and blood pressure, showed 100% positive associations (P < .05).
• EHR nudges had mixed associations with patient safety, effectiveness, and efficiency, with only 33.3% of patient safety measures showing improvements (P < .05).
• No significant association was found between EHR nudges and timeliness of care, as no studies assessed this measure.

IN PRACTICE:

EHR nudges may improve specific dimensions of health care quality (ie, descriptive, patient-centeredness). There were less consistent findings about how EHR nudges were associated with other healthcare quality measures (eg, effectiveness) and patient outcomes,” wrote the authors of the study.

SOURCE:

The study was led by Oliver T. Nguyen, MSHI, Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin. It was published online on September 17, in JAMA Network Open.

LIMITATIONS:

Most studies targeted physicians or nurses, limiting the generalizability to other care team members. Few studies were conducted in safety-net settings, which may require different approaches due to lower resources. The most commonly used EHR was Epic, limiting generalizability to other EHR vendors. None of the included studies controlled for adherence to evaluate EHR nudges, making interpretation of findings challenging.

DISCLOSURES:

Nguyen disclosed receiving grants from various organizations. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.