title: Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics.
abstract: 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.
authors.affiliation: Department of Community Health, Maccabi Healthcare Services, Tel Aviv, Israel. hoch@saad.org.il
authors.forename: Isaac
authors.initials: I
authors.lastname: Hoch
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Heymann
authors.forename: Irena
authors.initials: I
authors.lastname: Kurman
authors.forename: Liora J
authors.initials: LJ
authors.lastname: Valinsky
authors.forename: Gabi
authors.initials: G
authors.lastname: Chodick
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
mesh_terms: D000555:Ambulatory Care Information Systems; D002984:Clinical Laboratory Information Systems; D016303:Clinical Pharmacy Information Systems; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007557:Israel; D016347:Medical Records Systems, Computerized; D011188:Potassium / Q000097:blood*; D011314:Preventive Health Services; D017010:Reminder Systems
chemical_list: D004232:Diuretics; D011188:Potassium