How to Design Computerized Alerts to Ensure Safe Prescribing Practices

Feldstein, Adrianne C.; Simon, Steven R.; Schneider, Jennifer P.; Krall, Michael A.; Laferriere, Dan; Smith, David H.; Sittig, Dean F.; Soumerai, Stephen B.

doi:10.1016/s1549-3741(04)30071-7

Cited by 72 publications

(97 citation statements)

References 32 publications

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“…Selectively implementing streamlined computerized alerts with diverse functionality is essential to maximizing the alerts' effectiveness and clinician acceptance. [28][29][30] We did not find an additional effect of educational sessions and educational mailings beyond the effect of the alerts alone. The group educational sessions were focused on providing current prescribing information and facilitating discussions around the use of heavily marketed medications and less costly alternatives.…”

Section: Discussioncontrasting

confidence: 55%

Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

et al. 2009

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Section: Discussioncontrasting

confidence: 55%

Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

et al. 2009

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“…This CDS intervention was designed to alert clinicians whenever they attempted to order a medication that was contraindicated in elderly patients or one that had known serious interactions with warfarin. We used several methods, including focus groups, usability testing, and educational sessions with clinician users [51], to identify issues related to hardware/software, content, interface, people, measurement, workflow/communication, and internal policies and procedures. These efforts helped us, for example, to understand the need to meet with the organization's Pharmacy and Therapeutics (P & T) committee (i.e., internal policy) to convince them to modify the medication formulary as well as the information technology professional (i.e., people) who was responsible for maintaining the textual content of the alerts (i.e., font size, contents and order of the messages) to fit within the constraints of the alert notification window (i.e., user interface) which eliminated the need to train clinicians to use the horizontal scrolling capability.…”

Section: Hit Design and Developmentmentioning

confidence: 99%

A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

Sittig

Singh

2015

Health Informatics

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Conceptual models have been developed to address challenges inherent in studying health information technology (HIT). This manuscript introduces an 8-dimensional model specifically designed to address the socio-technical challenges involved in design, development, implementation, use, and evaluation of HIT within complex adaptive healthcare systems. The 8 dimensions are not independent, sequential, or hierarchical, but rather are interdependent and interrelated concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support, and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the "language" of clinical applications. The human computer interface includes all aspects of the computer that users can see, touch, or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end-user, including potential patient-users. Workflow and communication are the processes or steps involved in assuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organizational features (e.g., policies, procedures, and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.

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“…Others have proposed more parsimonious alerting (e.g., fewer triggers in a given system 18 ) or tailoring alerts to the specific characteristics of individual patients. 4,19 Our strategy was to direct these alerts to the AMS managers, rather than to the ordering clinicians. Kesselheim and colleagues recently suggested a similar approach of directing alerts to individuals who have responsibility for implementing them.…”

Section: Discussionmentioning

confidence: 99%

“Stealth” Alerts to Improve Warfarin Monitoring When Initiating Interacting Medications

et al. 2012

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BACKGROUND: As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients prescribed a medication that could interact with warfarin. Instead of alerting the prescribing provider, the system notified a multidisciplinary anticoagulation management service, so that the prescribing clinicians never saw the alerts. We aimed to determine whether these "stealth" alerts increased the frequency of anticoagulation monitoring following the co-prescription of warfarin and a potentially interacting medication. METHODS: We conducted a pre-post intervention study, analyzed using an interrupted time-series, within a large, multispecialty group practice that uses a common EHR. The study included a 12-month period preceding the intervention, a 2-month period during intervention implementation, and a 6-month post-intervention period. The primary outcome measure was the proportion of patients completing anticoagulation monitoring within 5 days of a new co-prescribing event. RESULTS: Prior to implementation of the stealth alert, 34 % of patients completed anticoagulation monitoring within 5 days after the prescription of a medication with a potential warfarin interaction. After implementation of the alert, 39 % completed testing within 5 days (odds ratio 1.24, 95 % confidence interval 1.12-1.37). CONCLUSIONS: Stealth alerts increased the proportion of patients who underwent anticoagulation monitoring following the prescription of a medication that could potentially interact with warfarin. This team-based approach to clinical-decision support directs alerts away from prescribing clinicians and toward individuals who can directly implement them.

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How to Design Computerized Alerts to Ensure Safe Prescribing Practices

Cited by 72 publications

References 32 publications

Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

Reducing the Prescribing of Heavily Marketed Medications: A Randomized Controlled Trial

A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

“Stealth” Alerts to Improve Warfarin Monitoring When Initiating Interacting Medications

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