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First published August 4, 2003 as JAMIA PrePrint; doi:10.1197/jamia.M1353
Journal of the American Medical Informatics Association 2003;10(6):541-546
© 2003 American Medical Informatics Association

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Submitted on March 3, 2003
Accepted on May 14, 2003

Country-wide Computer Alerts to Community Physicians Improve Potassium Testing in Patients Receiving Diuretics

Isaac Hoch MD1*, Anthony D. Heymann BSc, MSc1, Irena Kurman MSc1, Liora J. Valinsky MPH1, Gabi Chodick MSc, MHA1, and Varda Shalev MD, MPH1

Affiliation of the authors: 1 Maccabi Healthcare Services, Tel Aviv, Israel

* To whom correspondence should be addressed.

Over 20% of approximately 35,000 patients filling a diuretic prescription had no potassium blood test recorded within the previous year. A laboratory reporting system used throughout Israel by Maccabi Healthcare Services physicians was modified to provide physician alerts regarding potassium testing. The physicians were experienced users of a computerized medical record (CMR) that provided on-line laboratory test results. A nightly batch file checked pharmacy diuretic purchases against the patient's potassium blood test status. On-screen computer-generated reminders were sent to physicians of patients lacking a recent potassium test. Reminders to clinicians increased potassium testing by 9.8%. (p<0.001). Physician age and gender played a small part in predicting compliance to the alert, but specialty and practice size did not. The time delay between the date a reminder was sent and the potassium test date decreased steadily during the intervention. The success of this reminder system encourages expansion to include more drug/laboratory interactions. Furthermore, direct alerts to patients at multiple organization/patient contact points are planned.




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