Do We Want To Use EHRs To Foster Physician Behavior Changes?

Healthcare organizations already do much to foster physician behavior changes, to varying degrees of success. Sometimes they share educational materials, sometimes they pass on insurance company sanctions and once in a while, they choose the (to my mind) nuclear option and show doctors how they’re comparing to peers on some chosen criterion.

Although it’s a fairly logical step, I was surprised to read that some health systems have also begun to use EHRs to shape physician behavior more directly. According to a story appearing in FierceHealthcare, a handful of systems are toying with changing their EHRs’ user interface to quietly discourage unwanted choices.

The story draws on a discussion about using EHRs to nudge doctor behavior with Raj Ratwani, M.D., director of the national center for human factors in healthcare at Medstar Health. Ratwani notes that if an organization wants to change physician behavior, it can put undesired options lower down on drop-down menus or even grey those options out.

He notes that while EHRs may already use such techniques to avoid patient safety problems such as drug interactions or the administration of inappropriate doses, health systems could also use this approach to, for example, encourage physicians to avoid a drug that’s undergoing a shortage.

“Often what happens is providers get emails, and they’ll get an email that says ‘please don’t prescribe medication A, prescribe medication B instead.’ And then they’re tasked with having to remember that information on top of all the other things they have to do,” Ratwani told FH. “…It would be far more effective to manipulate the interface a little bit to make it more difficult to order those medications that are on shortage.”

Of course, this approach comes with its own set of considerations, he noted. For one thing, the person designing the UI changes may end up effectively making the decision, rather than the physician. Also, what if a system changes the UI to reflect a drug shortage, but doesn’t get around to updating the UI until much later?  What about other consequences you couldn’t predict?  We wander into a grey area at this point, but generally speaking, there’s clearly some risk associated with this approach as well.

How do you feel about the idea of influencing physician behavior change in this manner? Personally, it makes me more than a little bit uncomfortable.

I have little doubt that it will work to change behavior, as people respond dramatically when interfaces make it a cognitive challenge to proceed. (After all, that’s what workarounds are all about, isn’t it?) The thing is, it might be a better idea to address ugly workflow problems that prevent doctors from doing their jobs before you add any new challenges.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Great article Anne. To me, it seems clear that this is the future. In fact, I think it could become malpractice when a doctor chooses something that goes against the suggestion of the EHR. The key thing here is that the suggestion by the EHR needs to be driven by data. Certainly, there will be exceptions and the option for a doctor to override the system like they often do now, but as the data gets better, it’s going to become the exception when it comes to overriding the system. The problem now is that the data isn’t quite good enough to do this in mass scale, but it will get there. As you point out, the key is to have good data so that the EHR can be updated with the right suggestions.

  • Yeah, try that one time and see how much they ream you out. Talking about taking away their god given rights to clinical decision making and giving it to machines.

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