Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics

Abstract

More than 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 online 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.

Figures

Figure 1.

System description.

Figure 2.

Example of a physician reminder as it appears on the computer screen.

Figure 3.

Computer reminder flow chart.

Figure 4.

Proportion of patients in the general population who had potassium tests over the study period.

Figure 5.

First reminders and potassium tests performed in study population.

Figure 6.

Number of days between reminder and test, mean ( ± ) 95% CI.