An evaluation of the Veterans Health Administration's clinical reminders system: A national survey of generalists

Constance H. Fung, Jerry S. Tsai, Armine Lulejian, Peter Glassman, Emily Patterson, Brad N. Doebbeling, Steven M. Asch

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


BACKGROUND: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA. OBJECTIVE: Survey PCPs about usefulness and usability of VHA CCRs. DESIGN AND PARTICIPANTS: In a national survey, VHA PCPs rated on a 7-point scale usefulness and usability of VHA CCRs, and standardized scales (0-100) were constructed. A hierarchical linear mixed (HLM) model predicted physician- and facility-level variables associated with more positive global assessment of CCRs. RESULTS: Four hundred sixty-one PCPs participated (response rate, 69%). Scale Cronbach's alpha ranged from 0.62 to 0.82. Perceptions of VHA CCRs were primarily in the midrange, where higher ratings indicate more favorable attitudes (weighted standardized median, IQR): global assessment (50, 28-61), clinical/situational specificity (29, 17-42), integration with workflow/workload (39, 17-50), training (50, 33-67), VHA's management of CCR use (67, 50-83), design/interface (53, 40-67), perceived role in CCR use (67, 50-83), and self-efficacy (67, 57-78). In a HLM model, design/interface (p<.001), self-efficacy (p<.001), integration with workflow/workload (p<.001), and training (p<.001) were associated with more favorable global assessments of CCRs. Facilities in the west as compared to the south (p=.033), and physicians with academic affiliation (p=.045) had less favorable global assessment of CCRs. CONCLUSIONS: Our systematic assessment of end-users' perceptions of VHA CCRs suggests that CCRs need to be developed and implemented with a continual focus on improvement based on end-user feedback. Potential target areas include better integration into the primary care clinic workflow/workload.

Original languageEnglish (US)
Pages (from-to)392-398
Number of pages7
JournalJournal of General Internal Medicine
Issue number4
StatePublished - Apr 2008
Externally publishedYes


  • Decision support systems clinical
  • Evidence-based medicine
  • Medical records systems computerized
  • Primary health care
  • Quality of health care

ASJC Scopus subject areas

  • Internal Medicine


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