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

backgroundElectronic 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.

methodsWe 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.

resultsWe 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.

conclusionsThis 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 registrationNone.