by Dr. Scott Erdley, Senior Editor
This column was made possible by an educational grant from
Chamberlain College of Nursing
Erdley, S. (June, 2011).Reminders and reality – really?. Future Thoughts Now Column. Online Journal of Nursing Informatics (OJNI),15 (2). Available at http://ojni.org/issues/?p=525
It was brought to my attention I was tardy with delivery of an assignment (actually this column submission). It is true, I did submit in less than timely fashion (aka ‘late’). My inaction, in turn, provided the fodder for the column’s topic this go-round – REMINDERS. Those little things we all forget about but need to remember – are they best ‘remembered’ via little digital messages, little pieces of paper left out for me to see, or something else? In our everyday work and day-to-day lives there are countless ways to accomplish this task (the use of a daily calendaring book (analogue) to digital reminders from smart phones and other devices to refrigerator door notes)! And yet I continue to not attend to some, but not all, of my reminders (sigh).
In the health arena clinical information systems now are able to provide organizations and or institutions the ability to issue reminders to users for items and or tasks ranging from patient scheduling to when to draw samples for laboratory use to updating personnel records. And yet, use of these reminders, regardless of reason, continues to demonstrate inconsistent return (for example, Downs, Anand, Dugan & Carroll, 2010; Shojania et al., 2011). Interesting little phenomenon, eh?
One problem I have with reminders is they typically need to be constructed or entered by someone or ‘someones.’ I am one of those persons, who, if I do not do this sort of thing immediately on learning of something I need to be reminded of, will promptly forget to set the reminder and thereby insure I will indeed miss the event or task I want to attend or complete. So, what ends up happening is I indeed require a reminder to construct a reminder (if-you-will). This seems to be an exercise in absurdity at the least and too much work at the most (for me, anyway). In health care, reasons for reminders include critical lab value alerts, medication ordering and test ordering. Possible factors affecting this inconsistency range from presentation on screen to timeliness of response to just plain not reading the reminder.
So, at least in the US, the promotion of electronic health systems will continue, for the foreseeable future, to include this ancillary function to create reminders. This leads me to wonder, given the inconsistent outcomes of using reminders, will reminders continue to be integrated into clinical information systems? How might these reminders be made more effective in changing provider behavior? In addition, what are some alternatives to use of this sort of activity? Simplifying electronic records? OR, something such as simplifying our lives? Will reminders become destined as the next ‘meaningful use’ of EHRs?
In closing, the original reminder (J. A. P. Yensen, personal communication, April 15, 2011) led me to open up for discussion the idea of reminders in our clinical daily care, and, ultimately, beg me to wonder will such clinical reminders really work? Secondly, are we really so busy we need these reminders? What does this mean for our patients?
Feel free to post your thoughts to these questions as well as your own questions about technology and ‘the future’ here at OJNI and or email me ((firstname.lastname@example.org).
I look forward to reading your ideas and perspectives (after I set my computer calendar to remind me to do this :’)).
Downs, S. M., Anand, V., Dugan, T. M., & Carroll, A. E. (2010). You can lead a horse to water: Physicians’ responses to clinical reminders. AMIA Annual Symposium Proceedings, 2010, 167-71.
Shojania, K. G., Jennings, A, Mahew, A., Ramsay, C. R., Eccles, M. P. & Grimshaw, J. (2011). The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database of Systematic Reviews, 1, 2011.
I have been a Clinical Assistant Professor of Nursing, and affiliated with the Patient Simulation Center, used by the Nurse Anesthesia and Acute Care NP Programs, since 2000. I received my Doctorate of Nursing Science from the School of Nursing, University at Buffalo, State University of New York. I am also an alumnus of the School of Nursing having earned my B.S.N. and M.S. in 1989 and 1993, respectively. Recently I participated as a fellow in the Medical Informatics (MBL/NLM) Course held at the Marine Biological Laboratory, Woods Hole, MA (Spring 2002).
My interests and activities, with healthcare informatics, are currently in the areas of nursing information, information seeking, the use of high-fidelity simulation in education and health care informatics, and portable/personal digital devices. I manage several listservs including the Nrsing-l, the first list dedicated to nursing informatics. I have taught classes about health care informatics as well as the intersection of technology and care in acute care environments to undergraduate and graduate students.