Int J Med Inform - Changing course to make clinical decision support work in an HIV clinic in Kenya.

Tópicos

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Resumo

RPOSE: We implemented computer-based reminders for CD4 count tests at an HIV clinic in Western Kenya though an open-source Electronic Medical Record System. Within a month, providers had stopped complying with the reminders.METHODS: We used a multi-method qualitative approach to determine reasons for failure to adhere to the reminders, and took multiple corrective actions to remedy the situation.RESULTS: Major reasons for failure of the reminder system included: not considering delayed data entry and pending test results; relying on wrong data inadvertently entered into the system; inadequate training of providers who would sometimes disagree with the reminder suggestions; and resource issues making generation of reminders unreliable. With appropriate corrective actions, the reminder system has now been functional for over eight months.CONCLUSION: Implementing clinical decision support in resource-limited settings is challenging. Understanding and correcting root causes of problems related to reminders will facilitate successful implementation of the decision support systems in these settings.

Resumo Limpo

rpose implement computerbas remind cd count test hiv clinic western kenya though opensourc electron medic record system within month provid stop compli remindersmethod use multimethod qualit approach determin reason failur adher remind took multipl correct action remedi situationresult major reason failur remind system includ consid delay data entri pend test result reli wrong data inadvert enter system inadequ train provid sometim disagre remind suggest resourc issu make generat remind unreli appropri correct action remind system now function eight monthsconclus implement clinic decis support resourcelimit set challeng understand correct root caus problem relat remind will facilit success implement decis support system set

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