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

OBJECTIVE: Describe the impact of synchronous vs asynchronous clinical decision support (CDS) on clinician behavior in a single-site randomized, controlled environment. MATERIALS AND METHODS: Mixed effects binomial logistic regression was used to compare the impact of synchronous against asynchronous messaging on neurology orders in a three-arm study. RESULTS: 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). DISCUSSION: Alerts sometimes generate little action on the part of clinicians. In this case, asynchronous inbox messaging significantly increased neurology orders. CONCLUSION: Depending on context, asynchronous messaging may be superior to synchronous messaging when recommending a referral in an outpatient setting.