Supplementary Online Content

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1 Supplementary Online Content Loo TS, Davis RB, Lipsitz LA, et al. electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med. 2011;171(17): etable 1. Geriatric EMR Reminder Set etable 2. Performance on Quality Measures Before the Study etable 3. Odds Ratios Comparing EMR Reminders Plus Panel Manager With EMR Reminders Alone efigure. Electronic Medical Record Reminder Summary for a Provider s Panel This supplementary material has been provided by the authors to give readers additional information about their work.

2 etable 1. Geriatric EMR Reminder Set Reminder Detail Educational Link Reminders Studied in This Trial Advance directives Health care proxy -Prompt if age >65 y and field empty -Massachusetts Health care proxy forms -5 Wishes at Aging With Dignity Osteoporosis screen Vaccines -Prompt for women age >65 y -If BMD scan done previously, list date of last BMD scan -Prompt for influenza vaccine annually -Prompt for pneumococcal vaccine once >65 y -Caregroup PSN Guidelines to Osteoporosis Pharmacotherapy - Adult vaccination recommendations from ACIP/CDC Additional Reminders Included in the Geriatrics Reminder System Aspirin chemoprevention Fall screen Medication review -EMR calculates Framingham risk score from current data -If >10% risk, prompt to consider aspirin chemoprevention -Prompt annually for history of fall within last year or current walking or balance issue -Display Beers Criteria warnings on current medications -Targeted prompts for monitoring if on hypoglycemics with HbA 1c < 6.5 not tested in last 6 mo or digoxin and dose mg QD and estimated GFR <60 -NCEP ATP III calculator for risk stratification -AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update -Get Up and Go -Quality Indicators for Appropriate Medication Use in Vulnerable Elders Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults 2003 Vaccines -Prompt for tetanus vaccine every 10 y - Adult vaccination recommendations from ACIP/CDC Abbreviations: ACIP/CDC, Advisory Committee on Immunization Practices/Centers for Disease Control and Prevention; AHA, American Heart Association; BMD, bone mineral density; EMR, electronic medical record; GFR, glomerular filtration rate; HbA 1c, hemoglobin A 1c ; NCEP ATPIII, National Cholesterol Education Program Adult Treatment Panel III; PSN, Provider Service Network; QD, every day.

3 etable 2. Performance on Quality Measures Before the Study Control EMR Reminder EMR Reminder + Panel Manager P Value* Prior Year Performance** Health care proxy 6.3% (118/1859) 5.8% (73 /1254) 6.2% (83/1334).79 Initial bone density 25.2% (196/779) 26.8% (145/541) 30.0% (163/543).83 Influenza vaccine 63.6% (1227/1930) 63.5% (849/1336) 63.5% (885/1394).98 Pneumococcal vaccine 17.9% (284/1585) 14.1% (153/1088) 15.4% (181/1172).30 Patients Who Had Received Recommended Care Before the Beginning of the Study*** Health care proxy 9.8% (189/1930) 11.6% (155/1336) 10.3% (143/1394).26 Initial bone density 44.8% (473/1056) 47.8% (362/758) 55.0% (465/845).30 Pneumococcal vaccine 32.6% (629/1930) 30.0% (401/1336) 28.9% (403/1394).25 Abbreviation: EMR, electronic medical record. * Based on logistic regression model using generalized estimating equations to account for clustering by physician. ** Proportion of patients eligible for guideline on May 1, 2008, who complied May 2008 through April *** Proportion of eligible patients who were adherent to guideline on May 1, 2009.

4 etable 3. Odds Ratios* Comparing EMR Reminders Plus Panel Manager With EMR Reminders Alone Unadjusted Model Adjusted Model** Health care proxy 2.34 ( ) 2.37 ( ) Initial bone density 1.80 ( ) 1.62 ( ) Influenza vaccine 1.16 ( ) 1.22 ( ) Pneumococcal vaccine 1.40 ( ) 1.59 ( ) Abbreviation: EMR, electronic medical record. *Odds ratios and 95% confidence intervals. 95% confidence intervals that do not include 1.00 indicate statistically significant difference between EMR reminders and EMR reminders plus panel manager at P <.05. **Adjusted for primary care physicians preceding year performance and all patient characteristics (age, sex, years cared for by practice, and number of visits during study period).

5 efigure. Electronic Medical Record Reminder Summary for a Provider s Panel