Changing course to make clinical decision support work in an HIV clinic in Kenya

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. © 2010 Elsevier Ireland Ltd. All rights reserved.