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Interactive physician alerts improved patient CD4 counts
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A clinical decision-support system that generated interactive computer alerts for physicians regarding patient disease status improved patient CD4 counts and clinical follow-up in patients with HIV, according to an Annals of Internal Medicine report.
For the randomized, controlled trial, researchers from the Massachusetts General Hospital HIV Clinic tested the Virology FastTrack — a program created by the hospital that notifies clinicians of patient adverse events, including virologic failure, suboptimal follow-up and abnormal laboratory tests. The alerts were displayed on the providers’ electronic medical records page, patient-specific records page and sent via biweekly email.
From Sept. 18, 2007, to Sept. 17, 2008, physicians were randomly assigned to receive either the interactive alerts or static alerts that were only visible on patient-specific electronic medical records page. The study included 33 HIV care providers and 1,011 patients. During the first 12 months of the study, there were 2,368 interactive alerts and 90% were acknowledged by the providers.
At baseline, CD4 counts were similar between the groups. After the intervention, the mean CD4 count increase was higher among those whose physicians received the interactive alerts: 0.0053 vs. 0.0032 x 109 cells/L per month. In addition, the rate of suboptimal follow-up was lower among those whose physicians received interactive alerts: 20.6 events per 100 patient-years vs. 30.1 events per 100 patient-years.
In a survey after the study, 81% of the providers who completed the survey reported that the program saved time and 90% believed that the program improved clinical care and should be a standard part of clinical care.
“With informatics expected to play a crucial role in improving efficiency and lowering the cost of health care in the United States, it is critical to demonstrate meaningful use of the electronic medical record,” the researchers wrote. “The principles of FastTrack may readily transfer to other HIV clinical settings and inform the design of systems to support disease management and improve outcomes in HIV as well as other chronic diseases.”
Disclosure: The researchers report no relevant financial disclosures.
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