Case report Figure 2 The Louisiana Public Health Information Exchange (LaPHIE) Intervention Note. later, the alert continues to post with each return to the Patient Summary Screen, alerting the provider that action is still needed. Alerts responded to are turned off at patient discharge. When an alert triggers, an email notiﬁcation simultaneously posts to LSU HCSD personnel assigned to monitor LaPHIE to avoid missed opportunities when a provider chooses to Take Action Later or ignores an alert. Should an alert lack response, a unit supervisor can communicate to staff the need to follow-up with the patient. Implementation was phased into the LSU HCSD IDN by clinical venue and by hospital, starting with emergency departments in February 2009, and rolled out to all seven LSU HCSD hospitals by September 2009. A total of 442 clinicians (206 physicians and 236 nurses) were initially trained and serve as peer trainers. Formative evaluation of provider and patient acceptability Clinician acceptability was evaluated throughout the interven- tion. Interviews were conducted with clinician and public health end-users prior to launch to measure concerns regarding conﬁ- dentiality and exchange of sensitive information; these revealed support for the project, with the perception it would improve the care of both individual patients and the community. LaPHIE EMR alerts were designed with input from clinicians and public health personnel through an iterative prototype design process as well as clinician ‘cognitive walk through’ of the alert and CDS for evaluation of usability. In order to increase the acceptability and usability of the LaPHIE clinical messaging component, principles of participatory design and heuristic evaluation were utilized in the development of the LaPHIE Intervention Note. Components were rated on the following modiﬁed Nielsen- Schneiderman heuristics principles: Consistency, Visibility, Match, Complexity, Memory, Message, and Language.18 During development, the LaPHIE project team conducted focus groups (16 groups, n¼149) and 23 key informant inter- views with patients with HIV or other potentially life threat- ening and/or stigmatizing conditions who were infrequent users of healthcare. The purpose of the qualitative research was to 450 measure affected individuals’ opinions on the purpose and structure of this potentially controversial exchange of protected health information. RESULTS As shown in table 1, between 2/1/2009 and 1/31/2011, LaPHIE processed registration messages for 488 patient encounters and successfully identiﬁed, matched exactly, and exchanged messages on 345 unduplicated, HIV-positive patients in need of treatment. Clinicians responded to 73% of the alerts presented by documenting actions taken on the LaPHIE Intervention Note. Using OPH surveillance data and LSU EMR data, these identiﬁed individuals are being followed over time. Of these, 60% were $35 years old, 72% were African American/Black, and 62% were male. Of males, 22% acquired HIV through men having sex with men (MSM) behavior. Of women and men not reporting MSM exposure, 27% were infected via heterosexual contact and 66% had unknown risk (data not shown). These messages were viewed by 192 providers (51% physicians; data not shown). Three-quarters (76%) of the patients were aware of their HIV status but had not received care for >12 months. Of these, 68% had evidence of at least one visit to a non-HIV clinic since being diagnosed with HIV, representing missed opportu- nities to link these patients with treatment. Of those with known HIV status, the median time from last visit to point of identiﬁcation by LaPHIE was 20 (IQR 15e36) months. The majority (82%) followed up with HIV care within the study period, with 82% receiving at least one CD4 count during the 18-month follow-up study period and 62% having at least one HIV specialty visit. Ongoing research will assess the proportion of reengagement over time as more follow-up time accrues. Provider and patient acceptability As part of implementation, feedback mechanisms were built in for clinicians to communicate with project team members and clinicians are also spontaneously contacting project staff. Comments have included suggestions for what additional uses J Am Med Inform Assoc 2012;19:448e452. doi:10.1136/amiajnl-2011-000412