Clinical Decision Tools Within EHR That "Nudge" vs "Force" Boost Pathway Compliance, Study Finds


Debra A. Patt, MD, MPH, MBA, a breast cancer specialist at Texas Oncology is the lead author on the study being presented at ASCO.

Clinical-decision support tools that involve physicians in their design and are “iterative in process” can have a positive impact on improving compliance with evidence-based pathways, according to authors from Texas Oncology and US Oncology, reporting on results at the American Society of Clinical Oncology 2020 annual meeting.

Debra A. Patt, MD, MPH, MBA, a breast cancer specialist who is executive vice president for policy and strategic initiatives at Texas Oncology, is the lead author on an abstract that evaluates the impact of a clinical decision support system used within the electronic health record (EHR). The study looks at compliance rates with evidence-based clinical pathways across 9 statewide community-based oncology practices, covering 633 physicians who made more than 30,000 individual treatment decisions over a 6-month period.

The study covers a period between January 2014 and May 2016, before and after the new clinical decision support system was implemented.

According to the study authors, the evidence-based pathways that fuel the decision support system are developed by with input from physicians, who weigh in on the efficacy, toxicity, and value of various therapies. And yet, before the use of the clinical decision support system, only 58% of the physicians were following the pathways at least 75% of the time, the rate considered compliant by the network.

After adjusting for group effects on physician or practice behavior, the analysis found that the clinical decision support system improved physicians’ pathway compliance to 72% (P < .001). Data from individual practices showed the improvement was widespread, and authors concluded that the clinical decision support system incorporated into the EHR “significantly improved compliance” with evidence-based pathways.

The support tool helps ensure that clinical pathways are being followed, because it is “effective at improving targets of compliance broadly, at the practice, and at the individual clinician level,” the study found.

“Clinical informatics solutions that influence physician behavior can be inclusive of physicians in design, iterative in process, and nudge as opposed to force clinician behavior to drive quality improvement,” the authors concluded.

Texas Oncology and US Oncology, a division of McKesson, funded the study.


Patt DA, He B, Garey JS, et al. Driving quality improvement: How clinical decision support can facilitate compliance with evidence-based pathways. J Clin Oncol. 2020;38: (suppl; abstr 2045) doi:10.1200/JCO.2020.38.15_suppl.2045

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