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 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.
Hoch
Isaac
I
Department of Community Health, Maccabi Healthcare Services, Tel Aviv, Israel. hoch@saad.org.il
Heymann
Anthony D
AD
Kurman
Irena
I
Valinsky
Liora J
LJ
Chodick
Gabi
G
Shalev
Varda
V
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
D004232:Diuretics; D011188:Potassium