Abstract:
Purpose: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