When you're working in an HIV clinic that routinely sees 80 to
100 children in a single day, you don't have as much time for
thinking as you might like. The benches outside of your clinic room
are packed with mothers and grandmothers and aunties and children
of all ages. You have a huge stack of patient charts on your desk,
each one representing a child who needs to be seen. And as much as
you care about your patients (and as smart as you think you
are), your brain struggles to keep up.
In the face of this workload and each patient's complex set of
clinical problems, it is all too easy to miss things. A child needs
to have monitoring labs drawn every six months and needs regular
tests and chest x-rays and various prescriptions, but the children
are really sick and the families have complicated issues like not
having enough food or getting kicked out of their home because they
have HIV. And sometimes we doctors push things off until next
month's visit or just forget one of the many details that need to
be done. Does your baby need a certain test done today? Some times,
it gets lost in the blur of problems and prescriptions and other
It is into this gap that we have been working on computerized
reminders to help clinicians by reminding them when a child is
overdue to have something done. "It's time to order this lab," says
our reminder. Or, "this child is malnourished and needs to be
referred for nutrition support." We take information about the
patient from their electronic medical record and use it to give the
clinicians tailored reminders about what a given patient needs.
We think that things like this will work, but it's important to
actually have some proof! So, we've been running a study in the
pediatric HIV clinic in Kenya to see if our reminders work.
Happily, they do. We see a four-fold increase in how likely the
clinicians are to fix overdue problems in caring for children when
we remind them about it.
It's always great when things work! Our study shows that these
reminders work nicely, and so I had the chance to present those
results with a big group of several hundred pediatricians doing
international HIV work among children. My body is tired from
Kenya-Italy-Indiana-Washington DC travel, but it's lovely to be
among "my people" for the International Workshop on HIV Pediatrics.
I'm talking about our research work in Kenya, getting new ideas,
hearing about the amazing work other researchers are doing
(vaccines and cures for AIDS - how we need them!), and learning
lots about caring for children with HIV.