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

Coleman, J.J.; van der Sijs, H.; Haefeli, W.E.; Slight, S.P.; McDowell, S.E.; Seidling, H.M.; Eiermann, B.; Aarts, J.; Ammenwerth, E.; Ferner, R.E.; Slee, A.

Abstract

Background: Clinical 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. Methods: A 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. Results: We 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. Conclusions: We 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.

Citation

Coleman, J., van der Sijs, H., Haefeli, W., Slight, S., McDowell, S., Seidling, H., …Slee, A. (2013). 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, 13, Article 111. https://doi.org/10.1186/1472-6947-13-111

• Journal Article Type: Article
• Acceptance Date: Sep 25, 2013
• Online Publication Date: Oct 1, 2013
• Publication Date: Oct 1, 2013
• Deposit Date: Oct 29, 2013
• Publicly Available Date: Mar 31, 2014
• Journal: BMC Medical Informatics and Decision Making
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Article Number: 111
• DOI: https://doi.org/10.1186/1472-6947-13-111
• Keywords: Clinical Decision Support Systems, Medical Order Entry Systems.
• Public URL: https://durham-repository.worktribe.com/output/1475444