Changing course to make clinical decision support work in an HIV clinic in Kenya

Sheraz F. Noormohammad, Burke W. Mamlin, Paul Biondich, Brian McKown, Sylvester N. Kimaiyo, Martin C. Were

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. Methods: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. Results: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. Conclusion: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.

Original languageEnglish
Pages (from-to)204-210
Number of pages7
JournalInternational Journal of Medical Informatics
Volume79
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Reminder Systems
Clinical Decision Support Systems
Kenya
HIV
Electronic Health Records
CD4 Lymphocyte Count

Keywords

  • Clinical decision support
  • Developing countries
  • Electronic medical record
  • Technology adoption

ASJC Scopus subject areas

  • Health Informatics

Cite this

Changing course to make clinical decision support work in an HIV clinic in Kenya. / Noormohammad, Sheraz F.; Mamlin, Burke W.; Biondich, Paul; McKown, Brian; Kimaiyo, Sylvester N.; Were, Martin C.

In: International Journal of Medical Informatics, Vol. 79, No. 3, 03.2010, p. 204-210.

Research output: Contribution to journalArticle

Noormohammad, Sheraz F. ; Mamlin, Burke W. ; Biondich, Paul ; McKown, Brian ; Kimaiyo, Sylvester N. ; Were, Martin C. / Changing course to make clinical decision support work in an HIV clinic in Kenya. In: International Journal of Medical Informatics. 2010 ; Vol. 79, No. 3. pp. 204-210.
@article{12af3a0de89c4b08bd6093b0a4aebbc0,
title = "Changing course to make clinical decision support work in an HIV clinic in Kenya",
abstract = "Purpose: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. Methods: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. Results: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. Conclusion: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.",
keywords = "Clinical decision support, Developing countries, Electronic medical record, Technology adoption",
author = "Noormohammad, {Sheraz F.} and Mamlin, {Burke W.} and Paul Biondich and Brian McKown and Kimaiyo, {Sylvester N.} and Were, {Martin C.}",
year = "2010",
month = "3",
doi = "10.1016/j.ijmedinf.2010.01.002",
language = "English",
volume = "79",
pages = "204--210",
journal = "International Journal of Medical Informatics",
issn = "1386-5056",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - Changing course to make clinical decision support work in an HIV clinic in Kenya

AU - Noormohammad, Sheraz F.

AU - Mamlin, Burke W.

AU - Biondich, Paul

AU - McKown, Brian

AU - Kimaiyo, Sylvester N.

AU - Were, Martin C.

PY - 2010/3

Y1 - 2010/3

N2 - Purpose: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. Methods: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. Results: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. Conclusion: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.

AB - Purpose: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders. Methods: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation. Results: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months. Conclusion: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.

KW - Clinical decision support

KW - Developing countries

KW - Electronic medical record

KW - Technology adoption

UR - http://www.scopus.com/inward/record.url?scp=76049106295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=76049106295&partnerID=8YFLogxK

U2 - 10.1016/j.ijmedinf.2010.01.002

DO - 10.1016/j.ijmedinf.2010.01.002

M3 - Article

C2 - 20089444

AN - SCOPUS:76049106295

VL - 79

SP - 204

EP - 210

JO - International Journal of Medical Informatics

JF - International Journal of Medical Informatics

SN - 1386-5056

IS - 3

ER -