title: Development of an electronic medical record-based clinical decision support tool to improve HIV symptom management.
abstract: Common symptoms associated with HIV disease and its management are often underrecognized and undertreated. A clinical decision support tool for symptom management was developed within the Veterans Health Administration electronic medical record (EMR), aiming at increasing provider awareness of and response to common HIV symptoms. Its feasibility was studied in March to May 2007 by implementing it within a weekly HIV clinic, comparing a 4-week intervention period with a 4-week control period. Fifty-six patients and their providers participated in the study. Patients' perceptions of providers' awareness of their symptoms, proportion of progress notes mentioning any symptom(s) and proportion of care plans mentioning any symptom(s) were measured. The clinical decision support tool used portable electronic "tablets" to elicit symptom information at the time of check-in, filtered, and organized that information into a concise and clinically relevant EMR note available at the point of care, and facilitated clinical responses to that information. It appeared to be well accepted by patients and providers and did not substantially impact workflow. Although this pilot study was not powered to detect effectiveness, 25 (93%) patients in the intervention group reported that their providers were very aware of their symptoms versus 27 (75%) control patients (p = 0.07). The proportion of providers' notes listing symptoms was similar in both periods; however, there was a trend toward including a greater number of symptoms in intervention period progress notes. The symptom support tool seemed to be useful in clinical HIV care. The Veterans Health Administration EMR may be an effective "laboratory" for developing and testing decision supports.
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA. clnader@bu.edu
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Nader
authors.forename: Joel
authors.initials: J
authors.lastname: Tsevat
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Mrus
authors.forename: Forrest
authors.initials: F
authors.lastname: Levin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kozal
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: Steven
authors.initials: S
authors.lastname: Farber
authors.forename: Michelle
authors.initials: M
authors.lastname: Rogers
authors.forename: Joseph
authors.initials: J
authors.lastname: Erdos
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.forename: Ian
authors.initials: I
authors.lastname: Kudel
authors.forename: Ronald
authors.initials: R
authors.lastname: Braithwaite
mesh_terms: D000328:Adult; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000295:instrumentation*; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs