Are asynchronous or synchronous clinical decision support more likely to change provider behavior? A case study in dementia.

Abstract

Describe the impact of synchronous vs asynchronous clinical decision support (CDS) on clinician behavior in a single-site randomized, controlled environment. Mixed effects binomial logistic regression was used to compare the impact of synchronous against asynchronous messaging on neurology orders in a three-arm study. Asynchronous messaging resulted in a significant increase in patient neurology orders for evaluation (Odds ratio, alert-only arm: 1.88; 95% CI: 1.39, 2.55; alert and questionnaire arm: 1.99; 95% CI: 1.52, 2.62). Alerts sometimes generate little action on the part of clinicians. In this case, asynchronous inbox messaging significantly increased neurology orders. Depending on context, asynchronous messaging may be superior to synchronous messaging when recommending a referral in an outpatient setting.