title: Human factors barriers to the effective use of ten HIV clinical reminders.
abstract: OBJECTIVE
  Substantial variations in adherence to guidelines for human immunodeficiency virus (HIV) care have been documented. To evaluate their effectiveness in improving quality of care, ten computerized clinical reminders (CRs) were implemented at two pilot and eight study sites. The aim of this study was to identify human factors barriers to the use of these CRs.
  
  
  METHODS
  Observational study was conducted of CRs in use at eight outpatient clinics for one day each and semistructured interviews were conducted with physicians, pharmacists, nurses, and case managers.
  
  
  METHODS
  Detailed handwritten field notes of interpretations and actions using the CRs and responses to interview questions were used for measurement.
  
  
  RESULTS
  Barriers present at more than one site were (1) workload during patient visits (8 of 8 sites), (2) time to document when a CR was not clinically relevant (8 of 8 sites), (3) inapplicability of the CR due to context-specific reasons (9 of 26 patients), (4) limited training on how to use the CR software for rotating staff (5 of 8 sites) and permanent staff (3 of 8 sites), (5) perceived reduction of quality of provider-patient interaction (3 of 23 permanent staff), and (6) the decision to use paper forms to enable review of resident physician orders prior to order entry (2 of 8 sites).
  
  
  CONCLUSIONS
  Six human factors barriers to the use of HIV CRs were identified. Reducing these barriers has the potential to increase use of the CRs and thereby improve the quality of HIV care.
authors.affiliation: VA Getting at Patient Safety Center, Cincinatti VAMC, The Ohio State University, Columbus, OH 43210, USA. patterson.150@osu.edu
authors.forename: Emily S
authors.initials: ES
authors.lastname: Patterson
authors.forename: Anh D
authors.initials: AD
authors.lastname: Nguyen
authors.forename: James P
authors.initials: JP
authors.lastname: Halloran
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D001291:Attitude of Health Personnel; D003200:Computer User Training; D019983:Guideline Adherence; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D011585:Psychology, Applied; D017010:Reminder Systems / Q000706:statistics & numerical data*; D012984:Software; D016526:Workload