Raising CD4-Cell Counts . . . with an EMR?

Despite all their problems and annoyances, electronic medical records (EMRs) do hold the promise of streamlining health care delivery enough to improve not only efficiency but also actual health outcomes.

To explore the effect of EMRs on outcomes of HIV patients, researchers randomized about 1000 patients attending a single Boston HIV clinic to one of two types of computer-generated alerts for common problems. When control patients experienced virologic failure, failed to keep appointments, or developed new laboratory abnormalities, an alert appeared in their EMRs. But when patients randomized to “interactive provider alerts” had these problems, clinicians were notified directly both through the EMRs and by e-mail. Hyperlinks in the messages allowed clinicians to see pertinent details of the patient's history and — with a few additional clicks — to schedule an appointment or order repeat lab tests as indicated. For both groups, alerts were issued less aggressively for mild events than for serious ones.

Over the course of a year, the interactive-alert patients had a greater mean rise in CD4-cell count (5.3 vs. 3.2 cells/mm³ per month) and a lower rate of suboptimal follow-up (defined as >6 months between appointments) than controls. They also had a shorter median time to next scheduled appointment after a toxicity alert (2.79 vs. >6 months). On a survey conducted at the end of the year, most providers believed the alert system improved clinical care and should be part of routine care; administrative personnel also endorsed it.