A recent study by researchers from Northwestern University and the University of Sydney has found that primary care physicians are more likely to select high-quality treatment options when electronic health record (EHR) systems present them with two or more alternatives. The research, which involved 402 U.S.-based primary care doctors, was published on November 13 in JAMA Network Open.
The trial showed that when doctors were given two or more appropriate treatment choices in the EHR system, they selected an alternative 62% of the time. This is a significant increase compared to only 44% among those offered just one option. However, increasing the number of choices beyond two did not further improve decision-making.
“We have this unrealistic notion that doctors are rational all the time about the decisions we’re making for our patients, but we’re human, too,” said Dr. Jeffrey Linder, chief of general internal medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician who contributed to designing the study. “We’re trying to make it easier for physicians to do the right thing.”
The study’s authors suggest that health systems should design EHRs with prompts based on up-to-date evidence in order to guide physicians toward better care decisions. Dr. Linder noted that these curated prompts could influence decisions such as ordering tests, prescribing medications, or considering less-invasive treatments.
Lead author Gemma Altinger, an applied behavioral economist and Ph.D. candidate at the Faculty of Medicine and Health at the University of Sydney, highlighted concerns about outdated alerts in current EHR systems: “Doctors are getting more and more alerts during patient consultations, but if they are based on outdated evidence, the systems designed to improve care could end up doing more harm than good,” she said. “These very simple changes could support better care on a massive scale.”
In the experiment, participating physicians were asked to consider scenarios involving surgery referral for hip osteoarthritis and opioid prescribing for back pain. Control group doctors saw only one alternative treatment in their EHR interface; intervention groups saw two, three, or four alternatives.
This research challenges previous findings from a 1995 study suggesting that offering too many choices leads to "status-quo bias" and poorer decision-making due to overload. Instead, this new trial found no evidence supporting status-quo bias when multiple options were presented.
The project was funded by a research grant from the Faculty of Medicine and Health at The University of Sydney.