Yale University

Development of an electronic medical record-based clinical decision support tool to improve HIV symptom management.

TitleDevelopment of an electronic medical record-based clinical decision support tool to improve HIV symptom management.
Publication TypeJournal Article
Year of Publication2009
AuthorsNader, Claudia M., Joel Tsevat, Amy C. Justice, Joseph M. Mrus, Forrest Levin, Michael J. Kozal, Kristin Mattocks, Steven Farber, Michelle Rogers, Joseph Erdos, Cynthia Brandt, Ian Kudel, and Ronald Braithwaite
JournalAIDS patient care and STDs
Date Published2009 Jul
KeywordsAdult, Decision Making, Computer-Assisted, Decision Support Systems, Clinical, Female, HIV Infections, Humans, Male, Medical Records Systems, Computerized, Middle Aged, Patient Satisfaction, Physician's Practice Patterns, Pilot Projects, Practice Guidelines as Topic, Questionnaires, Severity of Illness Index, United States, United States Department of Veterans Affairs
AbstractCommon 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.
Alternate JournalAIDS Patient Care STDS

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