For benefits, see the evidence profile in the EtD framework referenced at the end of the previous section, available online. The percentage time out-of-INR range was lower in the electronic reminder group than in controls (adjusted OR for likelihood of being out of INR range, 0.64 [95% CI, 0.45-0.93]; very low certainty). There was no difference in median days with incorrect adherence between the electronic reminder and control groups (difference in the fully adjusted model for percentage incorrect adherence, 22.0% [95% CI, 28.2 to 4.2]; very low certainty). Harms and burden. There was no effect of electronic reminders on mortality and PE/DVT because these outcomes did not occur in any study patient. There was no difference in major bleeding between the electronic reminders group and controls (RR, 45 fewer to 178 more per 1000]; very low certainty). Other EtD criteria and considerations. Resource require- ments for the electronic reminder system would be large. Furthermore, the panel determined that given the requirement for specialized equipment, the intervention is probably not feasible to implement in most settings. Conclusions and research needs for this recommendation. Given the large uncertainty regarding net health benefit/harm from using electronic reminders to improve adherence to anticoagula- tion therapy for patients receiving treatment of VTE, the high costs, and the probable lack of feasibility, the panel suggests against using electronic reminders. See recommendation 13a for additional comments regarding adherence interventions in general and research needs pertaining to this recommendation. For patients receiving anticoagulation therapy for treatment of VTE, the ASH guideline panel recommends against using a daily lottery (see recommendation 13a) plus electronic re- minders (see recommendation 13b) to improve medication adherence (strong recommendation based on very low cer- tainty in the evidence about effects ). 