Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care

Rosenbloom, S. Trent; Geissbühler, Antoine; Dupont, William D.; Giuse, Dario A.; Talbert, Douglas A.; Tierney, William M.; Plummer, W. Dale; Stead, William W.; Miller, Randolph A.

doi:10.1197/jamia.m1627

Cited by 51 publications

(42 citation statements)

References 91 publications

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“…The passive alerts for medications requiring review, which persisted on the main screen until the alert expired or an expected drug action was taken, did not change the prescribing behavior of providers. Similar to previous studies using clinical decision support, the interruptive alerts were more effective at producing change in prescribing behavior than passive alerts42,43. We could not determine whether the low response rates to passive alerts were due to provider unawareness of the alert or deliberate judgment that no action was required.…”

Section: Discussionmentioning

confidence: 59%

A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report

McCoy

Waitman

Gadd

et al. 2010

American Journal of Kidney Diseases

110

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Background Frequently, prescribers fail to account for changing kidney function when prescribing medications. We evaluated the use of a computerized provider order entry intervention to improve medication management during acute kidney injury (AKI). Study Design Quality improvement report with time series analyses. Setting & Participants 1598 adult inpatients with a minimum 0.5 mg/dl increase in serum creatinine over 48 hours following an order for at least one of 122 nephrotoxic or renally cleared medications. Quality Improvement Plan Passive, non-interactive warnings about increasing serum creatinine appeared within the computerized provider order entry interface and on printed rounding reports. For contraindicated or high toxicity medications that should be avoided or adjusted, an interruptive alert within the system asked providers to modify or discontinue the targeted orders, mark the current dosing as correct and to remain unchanged, or defer the alert to reappear in the next session. Outcomes & Measurements Intervention effect on drug modification or discontinuation, time to modification or discontinuation, provider interactions with alerts. Results The modification or discontinuation rate per 100 events for medications included in the interruptive alert within 24 hours of increasing creatinine improved from 35.2 pre-intervention to 52.6 post-intervention (p<0.001); orders were modified or discontinued more quickly (p<0.001). During the post-intervention period, providers initially deferred 78.1% of interruptive alerts, although 54% of these were eventually modified or discontinued prior to patient death, discharge, or transfer. The response to passive alerts about medications requiring review did not significantly change when compared to baseline. Limitations Single tertiary care academic medical center; provider actions were not independently adjudicated for appropriateness. Conclusions A computerized provider order entry-based alerting system to support medication management following AKI significantly increased the rate and timeliness of modification or discontinuation of targeted medications.

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Section: Discussionmentioning

confidence: 59%

A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report

McCoy

Waitman

Gadd

et al. 2010

American Journal of Kidney Diseases

110

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“…Infobutton-like research grew in the late 1990s in the US 27,39–45 and soon expanded internationally 33,46 although adoption remained limited to a few early-adopting institutions. Following the requirement in 2011 for EHR products to adopt the Health Level Seven (HL7) “Infobutton Standard” for “Meaningful Use” certification, 9 infobutton-capable EHR systems and knowledge resources have proliferated.…”

Section: ) Resultsmentioning

confidence: 99%

Optimization of infobutton design and Implementation: A systematic review

Teixeira

Cook

Heale

et al. 2017

Journal of Biomedical Informatics

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Objective Infobuttons are clinical decision tools embedded in the electronic health record that attempt to link clinical data with context sensitive knowledge resources. We systematically reviewed technical approaches that contribute to improved infobutton design, implementation and functionality. Methods We searched databases including MEDLINE, EMBASE, and the Cochrane Library database from inception to March 1, 2016 for studies describing the use of infobuttons. We selected full review comparative studies, usability studies, and qualitative studies examining infobutton design and implementation. We abstracted usability measures such as user satisfaction, impact, and efficiency, as well as prediction accuracy of infobutton content retrieval algorithms and infobutton adoption/interoperability. Results We found 82 original research studies on infobuttons. Twelve studies met criteria for detailed abstraction. These studies investigated infobutton interoperability (1 study); tools to help tailor infobutton functionality (1 study); interventions to improve user experience (7 studies); and interventions to improve content retrieval by improving prediction of relevant knowledge resources and information needs (3 studies). In-depth interviews with implementers showed the Health Level Seven (HL7) Infobutton standard to be simple and easy to implement. A usability study demonstrated the feasibility of a tool to help medical librarians tailor infobutton functionality. User experience studies showed that access to resources with which users are familiar increased user satisfaction ratings; and that links to specific subsections of drug monographs increased information seeking efficiency. However, none of the user experience improvements led to increased usage uptake. Recommender systems based on machine learning algorithms outperformed hand-crafted rules in the prediction of relevant resources and clinicians’ information needs in a laboratory setting, but no studies were found using these techniques in clinical settings. Improved content indexing in one study led to improved content retrieval across three health care organizations. Conclusion Best practice technical approaches to ensure optimal infobutton functionality, design and implementation remain understudied. The HL7 Infobutton standard has supported wide adoption of infobutton functionality among clinical information systems and knowledge resources. Limited evidence supports infobutton enhancements such as links to specific subtopics, configuration of optimal resources for specific tasks and users, and improved indexing and content coverage. Further research is needed to investigate user experience improvements to increase infobutton use and effectiveness.

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“…Moreover, Inquiry API can be generated automatically, whenever the system displays a record entry that has been correlated to others resources, e.g., by means of an explicit hyperlink, or that is related to a medical handbook or local glossary, as in the case of abbreviations and acronyms. In this case, Inquiry API can help avoid and limit medication and transcription errors (Eslami et al 2008), as well as increase practitioners' access to educational materials (Rosenbloom et al 2005) and improve learning and knowledge retention (Knight et al 2005). Irrespectively of who or what creates it, Inquiry API is conceived to make practitioners aware of additional data that could help them interpret a specific inscription, in order to leverage what has been called redundancy by supplementary data (Cabitza et al 2005).…”

Section: Inquiry Apimentioning

confidence: 98%

Leveraging Coordinative Conventions to Promote Collaboration Awareness

Cabitza

Simone

Sarini

2009

Comput Supported Coop Work

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The paper discusses the conventions used by medical practitioners to improve their collaboration mediated by Clinical Records. The case study focuses on the coordinative conventions identified in two wards of an Italian hospital and highlights their role and importance in the definition of the requirements of any system supportive of collaborative work practices. These requirements are expressed in terms of the provision of artifact-mediated information that promotes collaboration awareness. The study identified several kinds of Awareness Promoting Information (API): the paper discusses how they can be conveyed both in the web of documental artifacts constituting a Clinical Record and in its computer-based counterpart, the Electronic Patient Record (EPR). The paper ends with the implications for the design of EPRs and for their integration with Hospital Information Systems in light of the findings.

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Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care

Abstract: Highlighting availability of context-sensitive educational materials and patient information through visible hyperlinks significantly increased utilization rates for study-related decision support when compared to "standard" VUH CPOE methods, although absolute response rates were low.

Cited by 51 publications

References 91 publications

A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report

A Computerized Provider Order Entry Intervention for Medication Safety During Acute Kidney Injury: A Quality Improvement Report

Optimization of infobutton design and Implementation: A systematic review

Leveraging Coordinative Conventions to Promote Collaboration Awareness

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