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Author Notes:

Corresponding author: John Bian, PhD, Associate Professor, Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, 715 Sumter St, Columbia, SC 29208; e-mail: jbian@sccp.sc.edu

This study was approved by Columbia Veterans Affairs (VA) Institutional Review Board and Research and Development Committee. Data management and statistical analyses of this study were conducted at the Atlanta VA Medical Center, Decatur, GA, and the manuscript was prepared at the South Carolina College of Pharmacy and William Jennings Bryan Dorn VA Medical Center, Columbia, SC.

Conception and design: John Bian, Charles L. Bennett, Maria Ribeiro, Joseph Lipscomb

Financial support: John Bian

Collection and assembly of data: John Bian

Data analysis and interpretation: John Bian, Charles L. Bennett, Deborah A. Fisher, Joseph Lipscomb

Manuscript writing: All authors

Final approval of manuscript: All authors

Disclosures: Consultant or Advisory Role: Deborah A. Fisher, Epic Genomics (compensated)



  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology

Unintended consequences of health information technology: Evidence from Veterans Affairs Colorectal Cancer Oncology Watch Intervention.


Journal Title:

Journal oof Clinical Oncology


Volume 30, Number 15


, Pages 3947-3952

Type of Work:

Article | Final Publisher PDF


Purpose: We evaluated the Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder implemented in Veterans Integrated Service Network 7 (including eight hospitals) to improve CRC screening rates in 2008. Patients and Methods: Veterans Affairs (VA) administrative data were used to construct four cross-sectional groups of veterans at average risk, age 50 to 64 years; one group was created for each of the following years: 2006, 2007, 2009, and 2010. We applied hospital fixed effects for estimation, using a difference-in-differences model in which the eight hospitals served as the intervention sites, and the other 121 hospitals served as controls, with 2006 to 2007 as the preintervention period and 2009 to 2010 as the postintervention period. Results: The sample included 4,352,082 veteran-years in the 4 years. The adherence rates were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention sites in 2006, 2007, 2009, and 2010, respectively, and the corresponding rates in the controls were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage point decrease in likelihood of adherence (P < .001). Additional analyses showed that the intervention was associated with a 5.6-percentage point decrease in likelihood of screening colonoscopy among the adherent, but with increased total colonoscopies (all indicators) of 3.6 per 100 veterans age 50 to 64 years. Conclusion: The intervention had little impact on CRC screening rates for the studied population. This absence of favorable impact may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physician fatigue resulting from the large number of clinical reminders implemented in the VA.

Copyright information:

© 2012 by American Society of Clinical Oncology.

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