Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics

More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium te...

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Bibliographic Details
Published in:Journal of the American Medical Informatics Association : JAMIA 2003-11, Vol.10 (6), p.541-546
Main Authors: Hoch, Isaac, Heymann, Anthony D, Kurman, Irena, Valinsky, Liora J, Chodick, Gabi, Shalev, Varda
Format: Article
Language:English
Subjects:
Ambulatory Care Information Systems
Clinical Laboratory Information Systems
Clinical Pharmacy Information Systems
Diuretics - adverse effects
Diuretics - therapeutic use
Humans
Israel
Medical Records Systems, Computerized
Potassium - blood
Preventive Health Services
Reminder Systems
The Practice of Informatics
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Summary:More than 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided online laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8% (p < 0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug-laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned.
ISSN:1067-5027
1527-974X
DOI:10.1197/jamia.M1353