Using an electronic health record alert to prompt blood-borne virus testing in primary care

Chadwick, David; Forbes, Gareth; Lawrence, Christopher; Lorrimer, Susan; Schaik, Paul van

doi:10.1097/qad.0000000000002935

Cited by 4 publications

(8 citation statements)

References 22 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This particular prompt, compared with other prompts, was considered simple to understand and easy to manage The prompt in the context of the consultation - Most discussed blood tests and submitted an order with the patient present. Some GPs ordered the test after the patient had left and were faced with the dilemma of whether to bring the patient back to discuss HIV testing - Many hospital-based and general practice HCWs felt the prompt was too late in the ordering process and disrupts the consultation, potentially opening up a new topic, causing irritation Perception Impact on time: Mixed views Driving perception: Either: - no mention of time - prompt causes test to be ordered after consultation - disruptive if prompt comes too late in the ordering process - potentially opens up a new topic right at the end of the consultation Chadwick et al 2021 [ 100 , 101 ] UK To evaluate a prototype application designed to prompt in real-time, BBV testing in previously untested higher risk individuals attending primary care Condition of focus : Blood-borne viruses Setting : General practice Tool : CDS to identify patients at risk of blood-borne viruses - Embedded/linked with EMR: Yes - Interruptive alert: Yes - User-driven: Clinician - Risk score: Yes Prospective cohort study Number of 'hard prompts' and clinicians' responses BBV tests ordered Survey of GPs Clinicians’ perceptions of the prompt system were positive with average additional time required for BBV test discussion in consultations estimated at 2 min Nineteen percent of clinicians reported having to make an additional appointment after a BBV test prompt because of insufficient time during a consultation and 15% had to make an additional appointment to discuss test results Free-text answers stressed the lack of time available Median additional consultation time varied from 0.25 min when the clinician ignored the prompt to 2 min when the prompt was accepted or declined Perception Impact on time: Increase Driving perception: limited time during consultations Chima et al 2019 [ 102 ] UK To summarise existing evidence on the effects of eCDSTs on decision making for cancer diagnosis in primary care, and determine factors that influence their successful implementation Condition of focus: Cancer Setting : General practice Tool : Range of CDS tools to support cancer diagnosis - Embedded/linked with EMR: Range - Interruptive alert: Range - User-driven: Range - Risk score: Range Systematic review …”

Section: Resultsmentioning

confidence: 99%

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

et al. 2023

View full text Add to dashboard Cite

Background Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. Methods A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. Results The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”. Conclusions The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

show abstract

Section: Resultsmentioning

confidence: 99%

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

et al. 2023

View full text Add to dashboard Cite

show abstract

“…121 Some studies (n = 10) mentioned 'alert fatigue' indicating that eCDS tools designed to support health professionals can increase the number of on-screen alerts, leading to a high chance of them being missed or ignored. 15,35,38,97,112,117,[122][123][124][125] None of these studies reported a decrease in consultation duration.…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 95%

“…Twenty-three of these reported the impact on 'work ow', regarding how eCDS tools altered the usual order in which patient-related tasks were carried out. 33,35,38,57,61,62,64,80,86,89,97,102,104,105,108,[113][114][115][116][117][118][119][120] Five referred to the impact of using eCDS tools on the trajectory of dialogue with patients, to the extent that follow-up appointments were arranged to avoid consultations running late. 35,72,114,115,118 One of these mentioned clinicians' concerns about 'taking time away' from other waiting patients, expressed as a barrier to the implementation of eCDS systems.…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

“…33,35,38,57,61,62,64,80,86,89,97,102,104,105,108,[113][114][115][116][117][118][119][120] Five referred to the impact of using eCDS tools on the trajectory of dialogue with patients, to the extent that follow-up appointments were arranged to avoid consultations running late. 35,72,114,115,118 One of these mentioned clinicians' concerns about 'taking time away' from other waiting patients, expressed as a barrier to the implementation of eCDS systems. 121 Some studies (n = 10) mentioned 'alert fatigue' indicating that eCDS tools designed to support health professionals can increase the number of on-screen alerts, leading to a high chance of them being missed or ignored.…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

“…Among the 36 studies that indicated a perceived increase in consultation duration, the most commonly highlighted concerns related to existing time pressures and lack of time during a consultation for clinicians to interact with eCDS tools and/or to carry out resultant recommended actions. 16,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] A prevalent view was that workload was 'already heavy' and that using eCDS tools would inevitably add burden. 36,38,39,[41][42][43][44][45][46][47][48] In the case of one tool to support delivery of preventive care through review of patients' lifestyle factors, the sense of lack of time for preventive care in general drove the view towards the tool increasing consultation duration.…”

Section: Perceived Increase In Consultation Durationmentioning

confidence: 99%

See 2 more Smart Citations

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Fletcher

Burns

Wiering

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.Methods: A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.Results: The search resulted in 5,594 references, leading to 91 full articles after screening. Of these, 33 studies were based in the USA, 20 in the UK and 11 in Australia. A further 22 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.Conclusions: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

show abstract

Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era

Boardman,

Boffito,

Chadwick

et al. 2023

Int J STD AIDS

View full text Add to dashboard Cite

Introduction Late diagnosis of HIV is associated with increased morbidity and mortality, and an increased risk of non-infectious comorbidities. On a societal level, late diagnosis leads to higher treatment and healthcare costs and is a major driver of HIV transmission. Despite improvements in other areas of the HIV care pathway, late diagnosis remains an individual and public health concern globally. Objective To examine the barriers to HIV testing and highlight successful strategies to improve prompt diagnosis. This review describes the prevalence of late diagnosis in the UK and discusses key factors that contribute to late diagnosis, including the effect of the COVID-19 pandemic. Late HIV diagnosis is lower in the UK than in most other European countries. In this review, pilot projects and ongoing initiatives that have reduced late diagnosis in the UK are highlighted; moreover, further strategies for improving prompt diagnosis are suggested. Conclusions Insufficient testing is the fundamental reason for late HIV diagnosis, with societal, systemic, and individual factors all contributing to inadequate testing. Improving access to testing, removing barriers to health-seeking behaviour, and ensuring all people with HIV indicator conditions are promptly tested are key to reducing the rates of late diagnosis globally.

show abstract

Using an electronic health record alert to prompt blood-borne virus testing in primary care

Cited by 4 publications

References 22 publications

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era

Contact Info

Product

Resources

About