Interactive CDS correlates with improved outcomes in HIV patients
Integrating non-invasive, interactive clinical decision support (CDS) alerts into the EHRs of HIV patients correlated with improved health outcomes, according to research published Dec. 4 by the Annals of Internal Medicine.
Researchers designed and implemented a CDS system, called Virology FastTrack, with an interactive scheduling mechanism at the Massachusetts General Hospital (MGH) HIV Clinic in Boston that alerted providers on their EHR homepages of patient adverse events and sent providers biweekly email updates on patient statuses. After a year-long study period, roughly 500 patients with EHRs using interactive CDS demonstrated a mean CD4 count increase of 0.0051 X 109 compared to a mean increase of 0.0031 X 109 demonstrated by a control group of roughly 500 with EHRs using static CDS, which only delivered alerts on patient-specific EHR pages.
Patients in the intervention group also demonstrated better performance against secondary measures compared to the control group. The median time to schedule an appointment after a suboptimal follow-up for the intervention group was 1.7 months compared to 3.5 months for the control group and the median time to an appointment after a first high toxicity reading was 2.8 months compared to more than six months. The six-month suboptimal follow-up rate was also lower for the intervention group, although there was no difference in laboratory test results for high grade toxicities.
The interactive CDS, which alerted providers to virologic failure according to HIV RNA levels, evidence of suboptimal follow-up and 11 abnormal laboratory test results, was designed to avoid overalerting “by sensoring alerts of the same grade as previously acknowledged alerts and those generated during inpatient admissions,” according to lead author Gregory K. Robbins, MD, MPH, an infectious disease specialist at MGH, and his colleagues.
Providers suggested that efforts to integrate the CDS into workflow were successful. More than 80 percent of providers who complete a post-study survey said the CDS saved time and more than 90 percent believed the CDS tool improved clinical care and should be adopted as a standard part of clinical care. Additionally, although designed for HIV care, the tool could be easily adjusted for other chronic diseases by modifying alerting algorithms, according to Robbins and his colleagues.
“With informatics expected to play a crucial role in improving efficiency and lowering the cost of healthcare in the United States, it is critical to demonstrate meaningful use of of the EHR,” Robbins et al concluded. “The principles of FastTrack may readily transfer to other HIV clinical settings and inform the design of systems to support disease management and improve outcomes in HIV as well as other chronic diseases.”