SynthesisJournal of the American Medical Informatics Association : JAMIA2023
Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review.
Synthesis in Journal of the American Medical Informatics Association : JAMIA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Electronic health records: managerial insights from an umbrella review.BMC health services research · 2026Pooled it
- Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care: A Systematic Review.JAMA network open · 2024Pooled it
- Learning from Misses: Evaluating a Clinical Decision Support for Chronic Pain Management in Primary Care.Applied clinical informatics · 2025Trial
- Elimination of the Opioid Sliding Scale Is Associated with Improved Opioid Stewardship Metrics.Joint Commission journal on quality and patient safety · 2026Article
- Digital solutions in acute medicine: Will electronic health records join up the patient journey (soon?).Future healthcare journal · 2026Article
- Lack of disparities in postoperative care after ileocecal resection in patients with Crohn's disease at tertiary inflammatory bowel diseases centers.Therapeutic advances in gastroenterology · 2026Article
- Clinical Decision Support to Increase Naloxone Co-prescribing from the Inpatient Setting.Journal of general internal medicine · 2026Observational
- Nudge for governmental change in health policy.Frontiers in public health · 2026Article
- A multicentric intervention based on nudging for the reduction of potentially unnecessary laboratory tests: insights from a Swiss hospital network.BMC health services research · 2025Observational
- Digital implementation strategy to increase SGLT2 inhibitor uptake in heart failure: Study design of EMAIL-HF.ESC heart failure · 2025Article
- A Hand to Hold.Journal of general internal medicine · 2025Article
- A Case Study: Optimizing CDS for Pediatric Oncology Trials by Transitioning from Interruptive to Passive Alerts.Applied clinical informatics · 2025Article
- Development of a Human Factors-Based Guideline to Support the Design, Evaluation, and Continuous Improvement of Clinical Decision Support.Mayo Clinic proceedings. Digital health · 2025Article
- Longitudinal study of the manifestations and mechanisms of technology-related prescribing errors in pediatrics.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Enhancing provider-patient connection through low-effort interventions: a scoping review protocol.BMJ open · 2024Article
- Pitfalls of reasoning in hospital-based transfusion medicine.Transfusion medicine (Oxford, England) · 2024Review
- The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design.JMIR formative research · 2024Article
- Nudging towards Sleep-Friendly Health Care: A Multifaceted Approach on Reducing Unnecessary Overnight Interventions.Applied clinical informatics · 2024Article
- Implementing Adult Hepatitis B Immunization and Screening Using Electronic Health Records: A Practical Guide.Vaccines · 2024Article
- Email-Based Nudges and Guideline-Concordant Statin Prescribing in a Federally Qualified Health Center Network: A Prospective Quality Improvement Initiative.Journal of primary care & community healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo describe the application of nudges within electronic health records (EHRs) and their effects on inpatient care delivery, and identify design features that support effective decision-making without the use of interruptive alerts. MATERIALS AND
methodsWe searched Medline, Embase, and PsychInfo (in January 2022) for randomized controlled trials, interrupted time-series and before-after studies reporting effects of nudge interventions embedded in hospital EHRs to improve care. Nudge interventions were identified at full-text review, using a pre-existing classification. Interventions using interruptive alerts were excluded. Risk of bias was assessed using the ROBINS-I tool (Risk of Bias in Non-randomized Studies of Interventions) for non-randomized studies or the Cochrane Effective Practice and Organization of Care Group methodology for randomized trials. Study results were summarized narratively.
resultsWe included 18 studies evaluating 24 EHR nudges. An improvement in care delivery was reported for 79.2% (n = 19; 95% CI, 59.5-90.8) of nudges. Nudges applied were from 5 of 9 possible nudge categories: change choice defaults (n = 9), make information visible (n = 6), change range or composition of options (n = 5), provide reminders (n = 2), and change option-related effort (n = 2). Only one study had a low risk of bias. Nudges targeted ordering of medications, laboratory tests, imaging, and appropriateness of care. Few studies evaluated long-term effects. DISCUSSION: Nudges in EHRs can improve care delivery. Future work could explore a wider range of nudges and evaluate long-term effects.
conclusionNudges can be implemented in EHRs to improve care delivery within current system capabilities; however, as with all digital interventions, careful consideration of the sociotechnical system is crucial to enhance their effectiveness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.