Guidelines for effective integration of information technology in the care of HIV-infected populations.
ABSTRACT Although information technology (IT) plays an increasingly important role in the delivery of healthcare, specific guidelines to assist human immunodeficiency virus (HIV) care settings in adopting IT are lacking.
Through the experiences of six Special Projects of National Significance - (SPNS) funded HIV-specific IT interventions, key considerations prior to adoption and evaluation of IT are presented. The purpose of this article is to provide guidelines to consider prior to adoption and evaluation of IT in HIV care settings.
Six sites conducted comprehensive evaluations of IT interventions between 2002 and 2005, encompassing care delivered to 24,232 clients by 700 providers. Six key considerations prior to adoption of IT in HIV care delivery were identified, including IT and programmatic capacity, expectations, participation, organizational models, end-user types, and challenges. Specific evaluation techniques included implementation assessment, formative evaluation, cost studies, outcomes evaluation, and performance indicators. Grantee experiences are used to illustrate key considerations.
With proper preparation, even resource-poor HIV care delivery programs can successfully adopt IT.
SourceAvailable from: Hamish S F Fraser
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ABSTRACT: Electronic health record (EHR) systems are often modified through the addition of new features over time. Few studies have examined the specific effects of such changes. We examined whether implementation of a bidirectional laboratory interface for order entry and data reporting within an existing ambulatory EHR would result in more prompt responses to laboratory indications for antiretroviral therapy (ART) changes or in improved communication with HIV+ patients about relevant laboratory results. We conducted a single-arm intervention study comparing the timeliness of ART regimen changes, HIV viral load (VL) outcomes and patient-reported assessments of care before and after implementation of a laboratory data exchange interface within an existing EHR, without changing the EHR ordering or results reporting user interface. Patient data was extracted from the EHR covering the period from 1 year before to 2 years after the intervention for a cohort of 1181 patients who had received care during the baseline year. The timeliness of ART changes was represented by the days from a laboratory-result "signal" (CD4 dropping below 350 or 200 or VL increasing by a half-log or to a value over 100,000) to an ART-change "response". Patient assessments of care were collected by interviewing 100 anonymous patients at baseline and another 125 at 2 years post-intervention. A total of 171 laboratory "signal" events were followed within 80 days by a change in ART therapy. The mean time from signal to therapy change (adjusted for clustering by patient) initially increased, from 37.7 days during the pre-intervention year to 48.2 days during the quarter immediately following activation of the lab intervention. It then declined to a mean of 31.4 days over the remaining 21 months of observation (P=0.03 for the 6-day improvement from the pre-period). A majority of patients (65%) achieved undetectable VL values by the end of the observation period; faster signal-response times were not associated with greater achievement of undetectable VL. Patients rated communication about laboratory tests more highly after implementation of the interface (91 vs. 83 on a 100-point scale, P=0.01); ratings were not higher for other aspects of care. Adding laboratory data exchange interfaces within existing EHRs holds promise for improving HIV care, both in the timeliness of responses to important laboratory results and in the quality of provider communication about lab tests. However, the benefits from this incremental change may be modest unless more extensive redesign of laboratory follow-up workflows is undertaken, with support from enhanced user interfaces that take advantage of the laboratory information delivered. Providers should also consider increased staffing to compensate for dips in follow-up performance during the initial post-implementation months.International Journal of Medical Informatics 08/2012; 81(10):e74-82. DOI:10.1016/j.ijmedinf.2012.07.012 · 2.72 Impact Factor
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ABSTRACT: Despite the effective use of computerized clinical summaries and reminders in high-income countries to increase the quality of care, the difficulties of implementing and deploying such systems in low-income countries have hindered their adoption. To become viable in these settings, clinical summaries and reminders systems must reliably deliver information while enabling healthcare providers to explore relevant data. This paper begins by explaining the need for summaries and reminders and how they might increase the efficiency of care. It then discusses the challenges similar systems have overcome and how those lessons learned apply to the context of providers in Sub-Saharan Africa. Finally, we describe the development of a phone-based clinical summaries and reminder system designed to increase the quality of Human immunodeficiency virus (HIV) care in Sub-Saharan Africa. In our evaluations, we will show through instrumentation and user studies that such a system is more available and can lead to more compliance with HIV testing guidelines.