Interactive alerts improve immune status of patients with HIVBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8217 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8217
In 2007, informatics experts at one US hospital developed and began testing a new clinical decision support system (CDSS) to streamline the management of outpatients with HIV. The system was embedded in the electronic medical record, and it alerted health professionals when patients needed an appointment because of new drug toxicity, virological failure, or suboptimal follow-up. The alerts were interactive and included short cuts to encourage appropriate action. They were emailed to providers twice a week, as well as appearing prominently on home pages in electronic medical records⇑.
The new CDSS was popular and seemed to work. In a randomised trial, patients in the new system had greater increases in CD4 cell counts than controls managed with straightforward static alerts (0.0053 v 0.0032×109 cells/L/month; difference 0.0021×109 cells/L/month; 95% CI 0.0001 to 0.004). They were seen more quickly after abnormal laboratory tests or an alert about poor follow-up. They had lower rates of suboptimal follow-up after six months (20.6 v 30.1 events per 100 patient years; P=0.022).
The authors tested their system, called FastTrack, in 1011 patients at the clinic, managed by 33 healthcare providers, mostly doctors. Training took just five minutes. The trial wasn’t perfect and took place in a single clinic with strong informatics infrastructure and back-up. But the results do suggest that well designed decision support can make a clinically relevant difference to patients with HIV, say the authors.
Cite this as: BMJ 2012;345:e8217