Hoch I et al. 2003 "Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics."

Hoch I, Heymann AD, Kurman I, et al. Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. J Am Med Inform Assoc 2003;10(6):541-546.
"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 [an EHR] 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."
To "describe the design, process, and results of" an alert system that generates "reminders for potassium blood testing in patients taking diuretics" to decrease adverse drug events.
Type Clinic
Primary care and specialty care
Urban and suburban
Other Information
"Maccabi Healthcare Services is the second largest nonprofit integrated health care provider in Israel. It includes 3,000 physicians providing care for over 1.6 million members."
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
Each night the system compiled a list of patients who had purchased diuretic medications and checked whether the potassium blood levels of these patients had been checked in the previous 12 months. If not, alerts were generated that were downloaded daily by physicians with their routine laboratory test results reports.
Context or other IT in place
An electronic health record (EHR) including "complete historical records of patient demographic data, physician data, laboratory results, and filled prescriptions information" was already in place. "The program provides full medical record functions, sim
Workflow-Related Findings
There was an absolute increase of 3 percent in the proportion of patients who had potassium laboratory tests in the postintervention period, with a relative increase of 9.8 percent.
"The monthly number of reminders required decreased steadily with time." "The time lag between the time the reminder was issued and the time the test was done was dependent on [when the physician read the reminder], when the physician gave the patient a referral and when the patient had the test done."
"A steady improvement was observed in the time delay between the first reminder date and when the patient had the subsequent potassium test done." Over the period of the study, the mean delay improved from 125 days to 46 days.
Over the study period, the number of patients having at least one potassium test steadily increased. "It appears that, as a result of this intervention, a large backlog of patients had their recommended blood work done per the physicians' request before reminders were issued."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 551 physicians. The inclusion criteria was that they had to have written at least 20 diuretic prescriptions over a 5 month period. Of the 551 physicians, 504 had both pre and postintervention data available and were included in the study.