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First published October 5, 2003 as JAMIA PrePrint; doi:10.1197/jamia.M1364
Journal of the American Medical Informatics Association 2004;11(1):50-59
© 2004 American Medical Informatics Association

A more recent version of this article appeared on January 1, 2004
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Submitted on March 14, 2003
Accepted on September 22, 2003

Human Factors Barriers to the Effective Use of Ten HIV Clinical Reminders

Emily S. Patterson PhD1*, Anh D. Nguyen MS2, James P. Halloran MSN, RN, CNS3, and Steven M. Asch MD, MPH4

Affiliation of the authors: 1 VA Getting at Patient Safety Center of Inquiry, Cincinnati VAMC, The Ohio State University Institute for Ergonomics, Columbus, OH; 2 West LA VAMC; 3 Center for Quality Management, VA Public Health Strategic Health Care Group; 4 West LA VAMC; RAND

* To whom correspondence should be addressed.

Objective Substantial variations in adherence to guidelines for HIV care have been documented. To evaluate their effectiveness in improving quality of care, ten computerized clinical reminders (CRs) were implemented at two pilot and eight study sites. The aim of this study was to identify human factors barriers to the use of these CRs.

Design Observational study of CRs in use at eight outpatient clinics for one day each and semi-structured interviews with physicians, pharmacists, nurses, and case managers.

Measurements Detailed handwritten field notes of interpretations and actions using the CRs. Responses to interview questions.

Results Barriers present at more than one site were: 1) workload during patient visits (8/8 sites), 2) time to document when a CR was not clinically relevant (8/8 sites), 3) inapplicability of the CR due to context-specific reasons (9/26 patients), 4) limited training on how to use the CR software for rotating (5/8 sites) and permanent staff (3/8 sites), 5) perceived reduction of quality of provider-patient interaction (3/23 permanent staff), and 6) the decision to use paper forms to enable review of resident physician orders prior to order entry (2/8 sites).

Conclusion Six human factors barriers to the use of HIV CRs were identified. Reducing these barriers has the potential to increase use of the CRs and thereby improve the quality of HIV care.




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