The role of electronic health records systems in de-implementing low-value care in primary care: a scoping review.

BACKGROUND: Electronic health record (EHR) systems have been used to support the implementation of evidence-based care. Growing evidence suggests that EHR systems can also support de-implementation of low-value care. However, a review of this literature has not been conducted. This scoping review will: 1) summarize how EHR-based interventions themselves have been used in primary care settings to de-implement low-value care, 2) summarize the effectiveness of these EHR interventions, 3) describe de-implementation strategies and outcome measures that have been used, and 4) describe facilitators and barriers that influence EHR-based de-implementation interventions. METHODS: We conducted a search using MEDLINE, CINAHL, Embase, and Web of Science on January 19, 2024 for peer-reviewed papers on EHRs and de-implementation in primary care. We inductively developed themes of how the EHR was used to support de-implementation. We mapped de-implementation strategies to a previously published taxonomy on implementation strategies, de-implementation outcomes to a previously published taxonomy on these outcomes, and facilitators and barriers to the Consolidated Framework for Implementation Research. We stratified study findings by EHR intervention type. RESULTS: We included 50 studies. EHRs supported de-implementation using four intervention types: 1) EHR alerts, 2) order sets and preference lists, 3) documentation templates, and 4) communication tools among the care team. The proportion of studies that showed favorable effectiveness in reducing low-value care ranged from 16.7% (communication tools) to 50.0% (documentation templates). Common strategies to support EHR-based de-implementation interventions included auditing and providing feedback, conducting educational meetings, and distributing educational materials. Twenty-two studies reported some assessment of de-implementation outcomes. Most EHR intervention types had numerous multi-level facilitators and barriers identified. CONCLUSIONS: This scoping review identified multiple EHR-based interventions that health systems use to support de-implementation and their effectiveness. Although promising, the evidence base is limited by the general lack of frameworks used for intervention development and de-implementation, unclear theoretical rationale to support the use of selected de-implementation strategies, and the unclear validity of de-implementation outcomes used. Additional research is needed to develop and validate frameworks and outcomes for de-implementation to strengthen the evidence base. TRIAL REGISTRATION: None.