On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop

BMC Medical Informatics and Decision Making

Research Article

Ann Slee¹  Robin E Ferner²  Hanna M Seidling³  Walter E Haefeli³  Birgit Eiermann⁴  Heleen van der Sijs⁵  Elske Ammenwerth⁶  Jos Aarts⁷  Sarah P Slight⁸  Sarah E McDowell⁹  Jamie J Coleman^1,10 

[1] College of Medical and Dental Sciences, University of Birmingham, B15 2SP, Birmingham, UK;College of Medical and Dental Sciences, University of Birmingham, B15 2SP, Birmingham, UK;West Midlands Centre for Adverse Drug Reactions, Dudley Road, B18 7QH, City Hospital, Birmingham, UK;Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany;Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, 14186, Stockholm, Sweden;Erasmus University Medical Centre, Department of Hospital Pharmacy, PO Box 2040, 3000, CA Rotterdam, The Netherlands;Institute of Health Informatics, UMIT – University of Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum I, 6060 Hall in Tirol, Austria;Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000, DR Rotterdam, The Netherlands;School of Medicine Pharmacy and Health, The University of Durham, TS17 6BH, Durham, UK;Division of General Internal Medicine, Brigham and Women’s Hospital, 02120, Boston, MA, USA;Harvard Medical School, 02115, Boston, MA, USA;University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, B15 2WB, Edgbaston, Birmingham, UK;University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, B15 2WB, Edgbaston, Birmingham, UK;College of Medical and Dental Sciences, University of Birmingham, B15 2SP, Birmingham, UK;West Midlands Centre for Adverse Drug Reactions, Dudley Road, B18 7QH, City Hospital, Birmingham, UK;

关键词: Clinical Decision Support Systems;    Medical Order Entry Systems;   

DOI  :  10.1186/1472-6947-13-111

 received in 2013-03-12, accepted in 2013-09-25,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundClinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority.MethodsA workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop.ResultsWe identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures.ConclusionsWe have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.

【 授权许可】

CC BY   
© Coleman et al.; licensee BioMed Central Ltd. 2013