Electronic Reminders Extend the Reach of Health Care

Many health care providers (HCPs) view the US Department of Veterans Affairs (VA) system of electronic reminders as a model. User experience and improvements that make clinical life easier (like automated text messaging, which requires no hands-on staff involvement) have brought more HCPs into the fold. And during a viral pandemic, preventive care is ever more important, as are the ways to provide it. But a recent Centers for Disease Control and Prevention (CDC) study shows some non-VA providers have some catching up to do.

Although the CDC researchers noted that electronic reminders can improve preventive and follow-up care, they also pointed out that HCPs must first have the computing capabilities to accomplish this. They analyzed 2017 data (the most recent available) from the National Electronic Health Records Survey of > 10,000 physicians and found only 65% of office-based physicians did.

Not surprisingly, practices that used electronic health record (EHR) systems were more than 3 times as likely to also have computerized capability to identify patients who needed preventive care or follow-up (71% vs 23% of practices without EHR). Primary care physicians were more likely than surgeons and other nonprimary care physicians to have the capability (73% vs 55% and 59%, respectively). Age also entered into it, with 70% of physicians aged between 45 and 54 years having the capability, compared with 57% of those aged 65 to 84 years. Offices with multiple physicians were more likely to have computerized capability.

The VA began using computerized clinical reminders 20 years ago to encourage patients to take better care of themselves to, for example, moderate alcohol use, manage cholesterol, or stop smoking. In 2006, the Veterans Health Information Systems and Technology Architecture (VistA) won an Innovations in American Government Award from Harvard University. The committee called VistA innovative because of its “unique linkage with standardized, consistent performance measurement.” VistA, the committee said, “substantially improves efficiency, reduces costs and demonstrably improves clinical decision-making.”

However, when the VA was getting its electronic reminder system up to speed, not all users were comfortable with it. Researchers who studied uptake of a system that sent reminders about lipid management to patients with ischemic heart disease found “substantial barriers” to implementation, including a possibly significant effect of “prior culture and attitudes” toward reminders.

Four years after the VA began using computerized reminders, attendees at “Camp CPRS,” a week-long meeting to train employees in the Computerized Patient Record System, were asked about facilitation and barriers. More than half of respondents could report at least 1 situation in which reminders helped them deliver care more effectively. But “[w]hile the potential benefits of such a system are significant,” the researchers said, “and in fact some VA hospitals are showing an increase in compliance with some best practices…it is generally understood that some providers within the VA do not use the clinical reminders.” Some HCPs said they were hard to use and cited insufficient training.

Experience and consistent use pay off, though. For instance, researchers from the VA Puget Sound Health Care System in Washington evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling at 8 VA sites. They wanted to determine how often the HCPs used the reminder, and whether it helped patients resolve unhealthy alcohol use. The study, involving 4,198 participants who screened positive for alcohol use, found 71% of the patients had the clinical reminder documented in the EHR—a high rate, the researchers noted, relative to other studies. The results were similar across the 2-year period, even in the first 8 months.

Sustainability also is a factor. At the time of their study, the researchers said, no health care system had achieved sustained implementation of brief alcohol counseling for patients who screened positive. Moreover, the patients who had reminders were significantly more likely to report having resolved unhealthy alcohol use at follow-up.

Do electronic daily reminders really improve adherence? Valentin Rivish, DNP, RN, NE-BC, telehealth specialist and facility e-consult coordinator with the Phoenix VA Health Care System in Arizona, wanted to see what evidence exists on telehealth adherence and utilization. He enlisted 40 veterans whose home-telehealth response rates were < 70%. Over 4 weeks, the veterans received an electronic daily reminder sent to their home-telehealth device, with the goal of having them respond daily.

As Rivish expected, daily reminders did improve adherence. After 4 weeks, 24 participants (60%) showed an increased response rate, and 14 (35%) achieved at least a 70% response rate pos-intervention. As a result, the Phoenix telehealth department has included the cost-effective intervention in its standard operating procedure.  

The VA has continued to add to its repertoire of ways to stay in touch with patients. In 2018, for instance, it launched VEText, a text messaging appointment-reminder system. According to the Veterans Health Administration Office of Veterans Access to Care, in just the first few months more than 3.24 million patients had received VEText messages (and had canceled 319,504 appointments, freeing up time slots for other veterans).

This year, the VA, US Department of Defense, and US Coast Guard launched a joint health information exchange (HIE) that allows partners to quickly and securely share EHR data bidirectionally with participating community healthcare providers. To that end, the 46,000-member HIE is collaborating with the CommonWell Health Alliance, adding a nationwide network of more than 15,000 hospitals and clinics.

“As a clinician who is using the joint HIE, the more patient information I have access to, the more I can understand the full picture of my patients’ care and better meet their needs,” says Dr. Neil Evans, a VA primary care physician and clinical leader with the Federal Electronic Health Record Modernization office. “During the COVID-19 pandemic, efficient electronic health information is more important than ever.”

Many health care providers (HCPs) view the US Department of Veterans Affairs (VA) system of electronic reminders as a model. User experience and improvements that make clinical life easier (like automated text messaging, which requires no hands-on staff involvement) have brought more HCPs into the fold. And during a viral pandemic, preventive care is ever more important, as are the ways to provide it. But a recent Centers for Disease Control and Prevention (CDC) study shows some non-VA providers have some catching up to do.

Although the CDC researchers noted that electronic reminders can improve preventive and follow-up care, they also pointed out that HCPs must first have the computing capabilities to accomplish this. They analyzed 2017 data (the most recent available) from the National Electronic Health Records Survey of > 10,000 physicians and found only 65% of office-based physicians did.

Not surprisingly, practices that used electronic health record (EHR) systems were more than 3 times as likely to also have computerized capability to identify patients who needed preventive care or follow-up (71% vs 23% of practices without EHR). Primary care physicians were more likely than surgeons and other nonprimary care physicians to have the capability (73% vs 55% and 59%, respectively). Age also entered into it, with 70% of physicians aged between 45 and 54 years having the capability, compared with 57% of those aged 65 to 84 years. Offices with multiple physicians were more likely to have computerized capability.

The VA began using computerized clinical reminders 20 years ago to encourage patients to take better care of themselves to, for example, moderate alcohol use, manage cholesterol, or stop smoking. In 2006, the Veterans Health Information Systems and Technology Architecture (VistA) won an Innovations in American Government Award from Harvard University. The committee called VistA innovative because of its “unique linkage with standardized, consistent performance measurement.” VistA, the committee said, “substantially improves efficiency, reduces costs and demonstrably improves clinical decision-making.”

However, when the VA was getting its electronic reminder system up to speed, not all users were comfortable with it. Researchers who studied uptake of a system that sent reminders about lipid management to patients with ischemic heart disease found “substantial barriers” to implementation, including a possibly significant effect of “prior culture and attitudes” toward reminders.

Four years after the VA began using computerized reminders, attendees at “Camp CPRS,” a week-long meeting to train employees in the Computerized Patient Record System, were asked about facilitation and barriers. More than half of respondents could report at least 1 situation in which reminders helped them deliver care more effectively. But “[w]hile the potential benefits of such a system are significant,” the researchers said, “and in fact some VA hospitals are showing an increase in compliance with some best practices…it is generally understood that some providers within the VA do not use the clinical reminders.” Some HCPs said they were hard to use and cited insufficient training.

Experience and consistent use pay off, though. For instance, researchers from the VA Puget Sound Health Care System in Washington evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling at 8 VA sites. They wanted to determine how often the HCPs used the reminder, and whether it helped patients resolve unhealthy alcohol use. The study, involving 4,198 participants who screened positive for alcohol use, found 71% of the patients had the clinical reminder documented in the EHR—a high rate, the researchers noted, relative to other studies. The results were similar across the 2-year period, even in the first 8 months.

Sustainability also is a factor. At the time of their study, the researchers said, no health care system had achieved sustained implementation of brief alcohol counseling for patients who screened positive. Moreover, the patients who had reminders were significantly more likely to report having resolved unhealthy alcohol use at follow-up.

Do electronic daily reminders really improve adherence? Valentin Rivish, DNP, RN, NE-BC, telehealth specialist and facility e-consult coordinator with the Phoenix VA Health Care System in Arizona, wanted to see what evidence exists on telehealth adherence and utilization. He enlisted 40 veterans whose home-telehealth response rates were < 70%. Over 4 weeks, the veterans received an electronic daily reminder sent to their home-telehealth device, with the goal of having them respond daily.

As Rivish expected, daily reminders did improve adherence. After 4 weeks, 24 participants (60%) showed an increased response rate, and 14 (35%) achieved at least a 70% response rate pos-intervention. As a result, the Phoenix telehealth department has included the cost-effective intervention in its standard operating procedure.  

The VA has continued to add to its repertoire of ways to stay in touch with patients. In 2018, for instance, it launched VEText, a text messaging appointment-reminder system. According to the Veterans Health Administration Office of Veterans Access to Care, in just the first few months more than 3.24 million patients had received VEText messages (and had canceled 319,504 appointments, freeing up time slots for other veterans).

This year, the VA, US Department of Defense, and US Coast Guard launched a joint health information exchange (HIE) that allows partners to quickly and securely share EHR data bidirectionally with participating community healthcare providers. To that end, the 46,000-member HIE is collaborating with the CommonWell Health Alliance, adding a nationwide network of more than 15,000 hospitals and clinics.

“As a clinician who is using the joint HIE, the more patient information I have access to, the more I can understand the full picture of my patients’ care and better meet their needs,” says Dr. Neil Evans, a VA primary care physician and clinical leader with the Federal Electronic Health Record Modernization office. “During the COVID-19 pandemic, efficient electronic health information is more important than ever.”

Many health care providers (HCPs) view the US Department of Veterans Affairs (VA) system of electronic reminders as a model. User experience and improvements that make clinical life easier (like automated text messaging, which requires no hands-on staff involvement) have brought more HCPs into the fold. And during a viral pandemic, preventive care is ever more important, as are the ways to provide it. But a recent Centers for Disease Control and Prevention (CDC) study shows some non-VA providers have some catching up to do.

Although the CDC researchers noted that electronic reminders can improve preventive and follow-up care, they also pointed out that HCPs must first have the computing capabilities to accomplish this. They analyzed 2017 data (the most recent available) from the National Electronic Health Records Survey of > 10,000 physicians and found only 65% of office-based physicians did.

Not surprisingly, practices that used electronic health record (EHR) systems were more than 3 times as likely to also have computerized capability to identify patients who needed preventive care or follow-up (71% vs 23% of practices without EHR). Primary care physicians were more likely than surgeons and other nonprimary care physicians to have the capability (73% vs 55% and 59%, respectively). Age also entered into it, with 70% of physicians aged between 45 and 54 years having the capability, compared with 57% of those aged 65 to 84 years. Offices with multiple physicians were more likely to have computerized capability.

The VA began using computerized clinical reminders 20 years ago to encourage patients to take better care of themselves to, for example, moderate alcohol use, manage cholesterol, or stop smoking. In 2006, the Veterans Health Information Systems and Technology Architecture (VistA) won an Innovations in American Government Award from Harvard University. The committee called VistA innovative because of its “unique linkage with standardized, consistent performance measurement.” VistA, the committee said, “substantially improves efficiency, reduces costs and demonstrably improves clinical decision-making.”

However, when the VA was getting its electronic reminder system up to speed, not all users were comfortable with it. Researchers who studied uptake of a system that sent reminders about lipid management to patients with ischemic heart disease found “substantial barriers” to implementation, including a possibly significant effect of “prior culture and attitudes” toward reminders.

Four years after the VA began using computerized reminders, attendees at “Camp CPRS,” a week-long meeting to train employees in the Computerized Patient Record System, were asked about facilitation and barriers. More than half of respondents could report at least 1 situation in which reminders helped them deliver care more effectively. But “[w]hile the potential benefits of such a system are significant,” the researchers said, “and in fact some VA hospitals are showing an increase in compliance with some best practices…it is generally understood that some providers within the VA do not use the clinical reminders.” Some HCPs said they were hard to use and cited insufficient training.

Experience and consistent use pay off, though. For instance, researchers from the VA Puget Sound Health Care System in Washington evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling at 8 VA sites. They wanted to determine how often the HCPs used the reminder, and whether it helped patients resolve unhealthy alcohol use. The study, involving 4,198 participants who screened positive for alcohol use, found 71% of the patients had the clinical reminder documented in the EHR—a high rate, the researchers noted, relative to other studies. The results were similar across the 2-year period, even in the first 8 months.

Sustainability also is a factor. At the time of their study, the researchers said, no health care system had achieved sustained implementation of brief alcohol counseling for patients who screened positive. Moreover, the patients who had reminders were significantly more likely to report having resolved unhealthy alcohol use at follow-up.

Do electronic daily reminders really improve adherence? Valentin Rivish, DNP, RN, NE-BC, telehealth specialist and facility e-consult coordinator with the Phoenix VA Health Care System in Arizona, wanted to see what evidence exists on telehealth adherence and utilization. He enlisted 40 veterans whose home-telehealth response rates were < 70%. Over 4 weeks, the veterans received an electronic daily reminder sent to their home-telehealth device, with the goal of having them respond daily.

As Rivish expected, daily reminders did improve adherence. After 4 weeks, 24 participants (60%) showed an increased response rate, and 14 (35%) achieved at least a 70% response rate pos-intervention. As a result, the Phoenix telehealth department has included the cost-effective intervention in its standard operating procedure.  

The VA has continued to add to its repertoire of ways to stay in touch with patients. In 2018, for instance, it launched VEText, a text messaging appointment-reminder system. According to the Veterans Health Administration Office of Veterans Access to Care, in just the first few months more than 3.24 million patients had received VEText messages (and had canceled 319,504 appointments, freeing up time slots for other veterans).

This year, the VA, US Department of Defense, and US Coast Guard launched a joint health information exchange (HIE) that allows partners to quickly and securely share EHR data bidirectionally with participating community healthcare providers. To that end, the 46,000-member HIE is collaborating with the CommonWell Health Alliance, adding a nationwide network of more than 15,000 hospitals and clinics.

“As a clinician who is using the joint HIE, the more patient information I have access to, the more I can understand the full picture of my patients’ care and better meet their needs,” says Dr. Neil Evans, a VA primary care physician and clinical leader with the Federal Electronic Health Record Modernization office. “During the COVID-19 pandemic, efficient electronic health information is more important than ever.”