Document Type


Degree Name



Department of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Purpose Electronic health records (EHRs) have the potential to improve measurability and quality of care, but excess alerting may reduce alert response through alert fatigue. In order to understand if targeting of alerts to primary care providers (PCPs) may be of value in decreasing alert fatigue, we looked at the extent and accuracy of PCP identification within one organization’s shared EHR and providers’ clinical decision support (CDS) use. We hypothesized that PCP identification in the system would vary by site, would be accurate, and that a PCP’s response to alerts would be highest during a provider’s primary care visits with their own patients, and lower when seeing a colleague’s patients. Methods All primary care visits to family medicine, internal medicine, and student health providers during a three-­‐month period were identified. EHR visit, CDS, and PCP data were retrieved for these visits from an enterprise data warehouse. The PCP identified in the chart was compared to the PCP who saw the patient for a plurality of prior visits. For a subset of visits, we examined CDS use for three common visit types: when a patient saw their PCP (PCP visits), when the patient saw another provider (non-­‐PCP visits), and when no PCP was identified at a visit (no-­‐PCP visits).

Results For 84,937 non-­‐resident primary care visits, a PCP was identified in 80.9% of visits. Of these, 68.9% of visits were to the PCP, 12.1% of visits were not to the PCP, and for 19.1% no PCP was listed. Identification of the PCP at primary care sites varied from 0.9% to 100%. Continuity of care by site similarly varied from 0% to 99.4% of visits. For the subset of visits where both a PCP and a plurality provider could be identified, the agreement between the chart-­‐listed PCP and the plurality PCP over one year of visits was high when compared to the PCP listed in the EHR (�=0.758). Providers responded to an alert in 28.7% of visits when seeing their own patients, in 12.6% of visits when not seeing their own patients, and in 6.9% of visits where no PCP is listed (p




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