Results: An electronic decision support tool called Diabetes Wizard was implemented in 6 HealthPartners Clinics from 10/06 through 5/07 as part of the NIDDK (068314) funded study entitled “ Reducing Clinical Inertia in Diabetes Care.” The Wizard was integrated into the electronic health record (EHR) as an EPIC smart form and accessed through the visit navigator screen at a patient’s encounter. It was also printed for provider review prior to entering the exam room. It gave clinically relevant data on the patient’s A1C, BP, lipids, and relevant co-morbidities. In addition it was programmed using complex algorithms derived through expert consensus to list 3-4 specific recommendations for drug intensification along with safety alerts and reminders for each of the three clinical domains.
61 providers were randomized at the clinic level to one of 3 study arms: (1) Control (2) SimCare Plus (a simulated case-based learning program for providers) or (3) DM Wizard. Six clinics received staff training and for 6 months received feedback, utilization reminders and paid incentives for Wizard use. Providers also completed a “visit action resolution” form (a check list of reasons for clinical inertia), and a provider survey assessed satisfaction. The following were tracked electronically during the 6 month intervention and incentive period and for 3 months after: (1) rate of opening the Wizard at eligible encounters (all visits of patients with diabetes) (2) rate of rooming staff printing the Wizard for the provider (3) rate of provider completion of the visit resolution form.
100% of providers agreed with listed treatment suggestions and would recommend use of the Wizard to other physicians. The form printed by rooming staff and made available prior to entering the exam room was seen as valuable by most providers. The Wizard was opened during eligible diabetes encounters 75% of the time, with printing and visit resolution completion rates of 88% and 87% of opened forms. 3 months after the incentive period, rates of opening the Wizard dropped to 50%.The DM Wizard EHR tool was implemented successfully with high provider use rates and satisfaction. Use declined substantially after the study intervention period correlating to discontinuation of feedback, reminders, and incentives. The cost of maintaining high rates of Wizard utilization and keeping algorithms up to date will need to be weighed against the clinical benefits achieved.