An electronic health system that alerts physicians with a yellow light when problems exist with a patient's care is being used by doctors at Northwestern Medicine. The system goes one step further by tying docs' responses to the alerts to quarterly performance reports.

Forty primary care physicians at Northwestern Medicine were part of a study which showing that, after one year of using the new system, it had significantly improved doctors' performance and the healthcare of patients with chronic conditions such as diabetes and cardiovascular disease. It also boosted preventive care in vaccinations and cancer and osteoporosis screenings.

Among the improvements: the number of heart disease patients receiving cholesterol-lowering medication rose from 87 to 93 percent, pneumonia vaccinations increased from 80 to 90 percent, and colon cancer screenings from 57 to 62 percent.

"The gains are modest, but if you are already at 90 percent and go to 94 percent, that's important," said lead author Stephen Persell, MD, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.

"It helps us find needles in the haystack and focus on patients who really have outstanding needs that may have slipped between the cracks," said Persell, who is also a researcher in the division of general internal medicine.

"Quality healthcare is not just about having good doctors and nurses taking care of you," he added. "It's having systems in place that make it easier for them to do their jobs and insure that patients get what they need."

To create the program, researchers used existing tools already available in a commercial electronic health record system. They integrated the health records with performance reports and paid close attention to the quality of information fed to physicians.

The system includes an unobtrusive yellow light on the side of a doctor's computer alerts them to a message that there is a problem with a patient's care. When the doctor clicks on the light, they may learn, for example, that a patient who has congestive heart failure hasn't gotten his or her recommended pneumonia vaccine, or perhaps was taken off beta-blockers during a recent hospitalization and needs to start them again.

"The pieces of this system aren't new, but putting them together in a comprehensive way is new," Persell noted. "If you put these things together in a smart way, then electronic health records are powerful tools for quality of care."

"What matters is how you use the electronic health records, so they make your job easier rather than act as a source of constant annoyance and false alarms," Persell said. "By showing only things that appear to be out of order, we are trying not to overwhelm the physician. If doctors get inaccurate alerts saying do this, do that, then they will ignore them."

Essential to the success of the program say study authors is that they system doesn't waste doctors' time, isn't annoying and is tied to performance reviews.

"You can't shove it in doctors' faces, or they walk away from it," Persell noted. "We used reminders that were not intrusive, but were still effective because doctors had faith that the data was accurate and they could enter data to make it more accurate."

David Baker, MD, senior author and chief of Northwestern Medicine's general internal medicine divison, added, "we wanted physicians to feel ownership of this. For this to work well, they have to view the alerts and reporting system as their personal quality improvement tools."

Doctors' interactions with the reminders were tied to quarterly performance reports based on their treatment of chronic disease and preventive care quality measures. They were willing to use the electronic tools, Persell believes, because they were regularly being reminded of their performance, and the tools were helping them improve it.

When a recommended treatment is not the medically right choice for a patient, the doctor is able to enter that information so that they won't be penalized in performance reports for not prescribing it.

The study is published online in the journal Medical Care and in the February print issue.