Evaluating the appropriateness of clinical decision support alerts: A case study

Abstract

Rationale, aims, and objectives Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio‐technical perspective. Method A qualitative case study evaluation was conducted at a 620‐bed public teaching hospital in Malaysia using interview, observation, and document analysis to investigate the features and functions of alert appropriateness and workflow‐related issues in cardiological and dermatological settings. The current state map for medication prescribing process was also modelled to identify problems pertinent to CDS alert appropriateness. Results The main findings showed that CDS was not well designed to fit into a clinician's workflow due to influencing factors such as technology (usability, alert content, and alert timing), human (training, perception, knowledge, and skills), organizational (rules and regulations, privacy, and security), and processes (documenting patient information, overriding default option, waste, and delay) impeding the use of CDS with its alert function. We illustrated how alert affect workflow in clinical processes using a Lean tool known as value stream mapping. This study also proposes how CDS alerts should be integrated into clinical workflows to optimize their potential to enhance patient safety. Conclusion The design and implementation of CDS alerts should be aligned with and incorporate socio‐technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.

Investigating the Antecedents of User Acceptance of Clinical Decision Support Systems: a Case from Saudi Arabia

“…Similar results occurred at inpatient and outpatient since (74.18%) and (71.17%) of the alerts were accepted by physicians respectively. These override rates are very low when compared to high alert overrides rates ranging between 49% and 96% as reported in recent research studies [70], [71].…”

The Reasons for Physicians and Pharmacists’ Acceptance of Clinical Support Systems in Saudi Arabia

“…Similar results occurred at inpatient and outpatient, with (74.18%) and (71.17%) of the alerts accepted by physicians, respectively. These override rates are meager when compared to high-alert override rates ranging between 49% and 96%, as reported in recent studies [ 70 , 72 ].…”

The Antecedents of Acceptance of Clinical Decision Support Systems by Physicians and Pharmacists in Saudi Arabia

“…Similar results occurred at inpatient and outpatient since (74.18%) and (71.17%) of the alerts were accepted by physicians, respectively. These override rates are meager when compared to high alert override rates ranging between 49% and 96%, as reported in recent research studies [70], [71].…”