ICMCC

the international council on medical & care compunetics

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22
August, 2014
Friday

alerts and reminders

The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

Vervloet M et al, J Am Med Inform Assoc, 2012

Background
Many patients experience difficulties in adhering to long-term treatment. Although patients’ reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence.
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2 May 2012 | No Comments »
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Improving completeness of electronic problem lists through clinical decision support: a randomized, controlled trial

Wright A et al, J Am Med Inform Assoc, 2012

Background
Accurate clinical problem lists are critical for patient care, clinical decision support, population reporting, quality improvement, and research. However, problem lists are often incomplete or out of date.
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20 January 2012 | No Comments »
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Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR

Wright A et al, Journal of General Internal Medicine, 27(1)

BACKGROUND
Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.

OBJECTIVE
To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.
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16 January 2012 | No Comments »
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Electronic Medical Record Reminders and Panel Management to Improve Primary Care of Elderly Patients

Loo TS et al, Arch Intern Med, 171(17)

Background
Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions.

Methods
We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period.
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28 September 2011 | No Comments »
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Use of telephone and SMS reminders to improve attendance at hospital appointments: a systematic review

Hasvold PE, Wootton R. Journal of Telemedicine and Telecare, 2011

Patients failing to attend hospital appointments contribute to inefficient use of resources. We conducted a systematic review of studies providing a reminder to patients by phone, short message service (SMS) or automated phone calls. A PubMed search was conducted to identify articles published after 1999, describing studies of non-attendance at hospital appointments. In addition, we searched the references in the included papers. In total, 29 studies were included in the review. Four had two intervention arms which were treated as independent studies, giving a total of 33 estimates. The papers were analysed by two observers independently. A study quality score was developed and used to weight the data. Weighted means of the absolute and the relative changes in non-attendance were calculated. All studies except one reported a benefit from sending reminders to patients prior to their appointment.
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28 September 2011 | No Comments »
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The effect of mobile phone text-message reminders on Kenyan health workers’ adherence to malaria treatment guidelines: a cluster randomised trial

Zurovac D et al, The Lancet, 378(9793)

Background
Health workers’ malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers’ mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya.
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8 August 2011 | No Comments »
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Physician Impressions of Using Text Message Technology to Increase Vaccination Compliance

Hart T et al, Telemedicine and e-Health, 17(6)

Introduction:
Immunization schedules are complicated and difficult for parents to remember. Parents are willing to receive text message reminders. However, it is unknown whether physicians are willing to implement such a system. The purpose of this study was to evaluate the feasibility of a text messaging reminder system from the physician’s perspective.

Materials and Methods:
Surveys were distributed in the winter of 2009–2010 by e-mail, facsimile, and telephone interview to 149 family physicians and pediatricians who provide immunizations in Sedgwick County, Kansas.
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19 July 2011 | No Comments »
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The marginal value of pre-visit paper reminders when added to a multifaceted electronic health record based quality improvement system

Baker DW et al, J Am Med Inform Assoc, 2011

Objective
We have reported that implementation of an electronic health record (EHR) based quality improvement system that included point-of-care electronic reminders accelerated improvement in performance for multiple measures of chronic disease care and preventive care during a 1-year period. This study examined whether providing pre-visit paper quality reminders could further improve performance, especially for physicians whose performance had not improved much during the first year.

Design
Time-series analysis at a large internal medicine practice using a commercial EHR. All patients eligible for each measure were included (range approximately 100-7500).
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19 June 2011 | No Comments »
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Evaluation of computer-generated reminders to improve CD4 laboratory monitoring in sub-Saharan Africa: a prospective comparative study

Were MC et al, J Am Med Inform Assoc, 18(2)

Objective
Little evidence exists on effective interventions to integrate HIV-care guidelines into practices within developing countries. This study tested the hypothesis that clinical summaries with computer-generated reminders could improve clinicians’ compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa.

Design
A prospective comparative study of two randomly selected outpatient adult HIV clinics in western Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic.
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19 March 2011 | No Comments »
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Coded entry versus free-text and alert overrides: What you get depends on how you ask

Seidling HM et al, International Journal of Medical Informatics, 79(11)

Purpose
A key trade-off in computerized clinical documentation exists between collecting coded data versus free-text. Coded data are more readily computer-readable and easier to reuse in different contexts. However, clinical information often exceeds the scope of commonly available terminologies, and coding may be resisted by providers. Alert override reasons are one domain for which agreed-upon terminologies are rarely used. Few data are available on how the collection of information affects the responses of providers.
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8 November 2010 | No Comments »
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Computerized Alert Reduced D-Dimer Testing in the Elderly

Palen TE et al, Am J Manag Care, 16(11)

Objective:
To assess the effect of a targeted age-specific computerized alert to reduce D-dimer testing in elderly patients.

Study Design:
A single-crossover cluster randomized trial of computerized alerts during physician order entry involving 8 ambulatory care clinics in a group-model integrated care delivery system.
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6 November 2010 | No Comments »
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Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction: A Randomized Controlled Trial

Strom BL et al, Arch Intern Med, 170(17)

Background
The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts.

Methods
To evaluate the effectiveness of a nearly “hard stop” CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007.
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28 September 2010 | No Comments »
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Preventing Potentially Inappropriate Medication Use in Hospitalized Older Patients With a Computerized Provider Order Entry Warning System

Mattison MLP et al. Archives of Internal Medicine, 170(15)

Background
Potentially inappropriate medication (PIM) use in hospitalized older patients is common. Our objective was to determine whether a computerized provider order entry (CPOE) drug warning system can decrease orders for PIMs in hospitalized older patients.
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10 August 2010 | No Comments »
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iFall: an Android application for fall monitoring and response

Sposaro, Frank, and Gary Tyson, Conf Proc IEEE Eng Med Biol Soc, 2009

Injuries due to falls are among the leading causes of hospitalization in elderly persons, often resulting in a rapid decline in quality of life or death. Rapid response can improve the patients outcome, but this is often lacking when the injured person lives alone and the nature of the injury complicates calling for help. This paper presents an alert system for fall detection using common commercially available electronic devices to both detect the fall and alert authorities. We use an Android-based smart phone with an integrated tri-axial accelerometer. Data from the accelerometer is evaluated with several threshold based algorithms and position data to determine a fall. The threshold is adaptive based on user provided parameters such as: height, weight, and level of activity.
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4 April 2010 | No Comments »
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Effect of point-of-care computer reminders on physician behaviour: a systematic review

Shojania KG et al, CMAJ, 182(5)

Background:
The opportunity to improve care using computer reminders is one of the main incentives for implementing sophisticated clinical information systems. We conducted a systematic review to quantify the expect ed magnitude of improvements in processes of care from computer reminders delivered to clinicians during their routine activities.
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9 March 2010 | No Comments »
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Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?

Singh, Hardeep et al, The American Journal of Medicine, 123(3)

Background
Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medical records can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medical record resulted in timely follow-up actions.
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8 March 2010 | No Comments »
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Using electronic health record alerts to provide public health situational awareness to clinicians

Lurio, Joseph et al, J Am Med Inform Assoc, 17(2)

Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks.
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28 February 2010 | No Comments »
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Functionality test for drug safety alerting in computerized physician order entry systems

van der Sijs, Heleen et al, International Journal of Medical Informatics, 2010

Purpose
To evaluate the functionality of drug safety alerting in hospital computerized physician order entry (CPOE) systems by a newly developed comprehensive test.

Methods
Comparative evaluation of drug safety alerting quality in 6 different CPOEs used in Dutch hospitals, by means of 29 test items for sensitivity and 19 for specificity in offices of CPOE system vendors. Sensitivity and specificity were calculated for the complete test, and for the categories “within-order checks”, “patient-specific checks”, and “checks related to laboratory data and new patient conditions”. Qualitative interviews with 16 hospital pharmacists evaluating missing functionality and corresponding pharmacy checks.
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12 February 2010 | No Comments »
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Cell-Phone Medicine Brings Care To Patients In Developing Nations

Feder, J. Lester, Health Affairs, 29(2)

At ten o’clock in the morning, a clinic in Mexico City’s Condesa neighborhood is buzzing with activity. It serves some 7,000 patients and is operated by the Mexico City government, making it one of the largest facilities in Latin America devoted to treating patients with HIV/AIDS.
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2 February 2010 | No Comments »
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Changing course to make clinical decision support work in an HIV clinic in Kenya

Noormohammad, Sheraz F. et al, International Journal of Medical Informatics, 2010

Purpose
We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders.

Methods
We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation.
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22 January 2010 | No Comments »
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