JAMIA: EMRs can improve quality of care in resource-limited countries

Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa, according to research published in the March edition of Journal of the American Medical Informatics Association.

Martin C. Were, MD, MS, assistant professor of medicine at the Indiana University School of Medicine and a Regenstrief Institute investigator, both located in Indianapolis, and colleagues reported that computer-generated reminders about overdue tests yielded nearly a 50 percent increase in the appropriate ordering of cluster of differentiation 4 (CD4) blood tests. CD4 counts are critical to monitoring the health of patients with HIV and guide treatment decisions.

The researchers sought to test the hypothesis that clinical summaries with computer-generated reminders could improve clinicians’ compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa.

The research evaluated changes in order rates for overdue CD4 tests that were compared between and within two clinics in Eldoret, Kenya. Printed summaries with reminders for overdue CD4 tests were made available to clinicians in the intervention clinic but not in the control clinic.

The computerized reminder system identified 717 encounters (21 percent) with overdue CD4 tests. Analysis by study assignment (regardless of summaries being printed or not) revealed that with computer-generated reminders, CD4 order rates were significantly higher in the intervention clinic compared with the control clinic (53 percent vs. 38 percent).

When comparison was restricted to encounters where summaries with reminders were printed, order rates in the intervention clinic were even higher (63 percent). The intervention clinic increased CD4 ordering from 42 percent before reminders to 63 percent with reminders (a 50 percent increase), compared to the control clinic, which had only an 8 percent increase from the prestudy baseline.

“Clinical summaries with computer-generated reminders significantly improved clinician compliance with CD4 testing guidelines in the resource-limited setting of sub-Saharan Africa,” concluded the authors. “This technology can have broad applicability to improve quality of HIV care in these settings.”

The Academic Model Providing Access to Healthcare (AMPATH) clinics in the study employ OpenMRS, an open source EMR system widely used in the developing world.

This study was primarily supported by a grant from the Abbott Fund.