Singh H et al, JAMA internal medicine, 2013
Electronic health record (EHR)-based alerts are often used to notify practitioners of abnormal test results, but follow-up failures (missed results) continue to occur in outpatient settings. In the Department of Veterans Affairs (VA), abnormal test result alerts are generated automatically for prespecified abnormal laboratory values or manually by the interpreting radiologist when an unexpected finding is noted.
[ More ]
van der Sijs H et al, J Am Med Inform Assoc, 13(2)
Many computerized physician order entry (CPOE) systems have integrated drug safety alerts. The authors reviewed the literature on physician response to drug safety alerts and interpreted the results using Reason’s framework of accident causation. In total, 17 papers met the inclusion criteria. Drug safety alerts are overridden by clinicians in 49% to 96% of cases. Alert overriding may often be justified and adverse drug events due to overridden alerts are not always preventable. A distinction between appropriate and useful alerts should be made.
[ More ]
Russ AL et al, International Journal of Medical Informatics, 81(4)
Few studies have examined prescribers’ interactions with medication alerts at the point of prescribing. We conducted an in situ, human factors investigation of outpatient prescribing to uncover factors that influence the prescriber–alert interaction and identify strategies to improve alert design.
[ More ]
Kesselheim AS et al, Health Affairs, 30(12)
Clinical decision support systems—interactive computer systems that help doctors make clinical choices—can reduce errors in drug prescribing by offering real-time alerts about possible adverse reactions. But physicians and other users often suffer “alert fatigue” caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems’ effectiveness.
[ More ]
Hysong S et al, BMC Medical Informatics and Decision Making, 11(1)
Notifying clinicians about abnormal test results through electronic health record (EHR) -based “alert” notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.
We conducted a qualitative study consisting of six 6-8 member focus groups (N=44) at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory) and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow.
Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification.
Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.
Fiks AG et al, Pediatrics, 120(4)
The objective of this study was to test the hypothesis that clinical alerts for routine pediatric vaccinations within an electronic health record would reduce missed opportunities for vaccination and improve immunization rates for young children in an inner-city population.
A 1-year intervention study (September 1, 2004, to August 31, 2005) with historical controls was conducted in 4 urban primary care centers affiliated with an academic medical center. All children who were younger than 24 months were enrolled. Electronic health record–based clinical reminders for routine childhood vaccinations were programmed to appear prominently at every patient encounter with vaccines due. The main outcome measures were rates of captured immunization opportunities and overall immunization rates at 24 months of age.
[ More ]
Yu DT et al, Pharmacoepidemiology and Drug Safety, 20(2)
The Food and Drug Administration issues black-box warnings (BBWs) regarding medications with serious risks, yet physician adherence to the warnings is low.
We evaluated the impact of delivering BBW-based alerts about drug–drug, drug–disease, and drug–laboratory interactions for prescription medications in outpatients in an electronic health record with clinical decision support. We compared the frequency of non-adherence to all BBWs about drug–drug, drug–disease, and drug–laboratory interactions for 30 drugs/drug classes, and by individual drugs/drug groups with BBWs between the pre- and post-intervention periods. We used multivariate analysis to identify independent risk factors for non-adherence to BBWs.
[ More ]
Garrett NY et al, Journal of Public Health Management and Practice, 17(1)
Public health agencies including federal, state, and local governments routinely send out public health advisories and alerts via e-mail and text messages to health care providers to increase awareness of public health events and situations. Agencies must ensure that practitioners have timely and accessible information at the critical point-of-care. Electronic health record (EHR) systems have the potential to alert physicians of emerging health conditions deemed important for public health at the most critical time of need. To understand how public health agencies can leverage existing alerting mechanisms in EHR systems, it is important to understand characteristics of public health alerts to determine their suitability for alerting in EHR systems.
[ More ]