Use of Clinical Electronic Medical Record Systems for Targeted Recruitment of Older Adults for Research: Facilitators and Barriers

IntroductionRecruiting older adults into clinical research studies presents unique challenges that can result in failure to meet recruitment targets and contribute to underrepresentation.This article identifies facilitators and barriers to using Electronic Medical Record (EMR)-based alerts to identify eligible older adults for a time-sensitive protocol. Materials and MethodsWe analyzed a case example in which EMR-based alerts were used to identify older adults with early-stage lower extremity wounds.We examined operational, regulatory, and workflow factors that influence EMR-based alert recruitment and applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers associated with this approach. ResultsDuring the wound study recruitment period, EMR-based alerts automatically triggered 198 times for 123 unique patients across five clinical settings.Of these patients, seven (6%) were referred through EMR-based alerts, whereas traditional recruitment methods including flyers, and provider reminders, yielded no referrals.Referral yield varied by clinical setting, with the highest performance in the Geriatrics clinic (4/39 patients, 10%).Barriers included workflow disruption, alert fatigue, poorly timed notifications, inaccurate patient identification, limited familiarity with the study, and institutional policies requiring providermediated referrals. ConclusionDespite significant institutional investment in EMR infrastructure, limitations related to data quality, workflow alignment, provider engagement, and institutional recruitment policies continue to impede effective use of EMR-based alerts for research recruitment of older adults.Improving alert design, reducing provider burden, and addressing regulatory barriers, may enhance the identification and recruitment of eligible older adults using this method, particularly for time-sensitive studies and recruitment in outpatient care settings.