Provider Survey on Automated Clinical Decision Support for Cardiovascular Risk Assessment

Abstract

ObjectiveTo investigate provider opinions regarding a clinical decision support (CDS) system for cardiovascular risk assessment and for the creation of a replacement system.MethodsFrom March to April 2018, an invitation letter with a link to a self-administered web-based survey was sent via e-mail to 279 providers with primary appointment in the Department of Cardiovascular Medicine, Mayo Clinic, Rochester. The e-mail was sent to providers on March 8, 2018 and the survey closed on April 16, 2018.ResultsOne hundred providers responded to the survey yielding an overall response rate of 35.8%. Of these, 52 (52%) indicated they had used the cardiovascular (CV) risk profile CDS system and were classified as users and prompted to continue the survey. Among users, 42 (80.8%) indicated use of the CDS was either important (25; 48.1%) or very important (17; 32.7%) in their clinical practice; 45 (86.5%) responded that the system was very easy (17; 32.7%) or easy (28; 53.8%) to use. In addition, 48 (96.0%) users indicated that the CV risk profile supported their thought process at the point-of-care; 47 (97.9%) users indicated similar functionalities should be implemented into the new electronic health record system and 41 (85.4%) users reported new functionalities should also be incorporated.ConclusionsFor most users, the CDS system was easy to use and supported clinical thought process at the point-of-care. Users also felt their practice was supported and should continue to be supported by CDS systems providing individualized patient information at the point-of-care.

Clinician Perspectives on Clinical Decision Support for Familial Hypercholesterolemia

“…CDS alerts can improve patient safety, support diagnostic decisions, and facilitate clinical management [ 18 , 19 ]. However, they can also add to the user’s cognitive burden through alert fatigue, especially when a high volume of alerts is received, the alerts are not applicable, or they contain dense information in a time-limited setting [ 20 ].…”

Lessons Learned from Creating Alert Governance during an Electronic Health Record Transition

“…A growing body of literature suggests that EHR conversions pose inherent risks to CDS performance. 7 The new EHR we were in the process of adopting has been shown elsewhere to worsen DDI alert burden, 8 to displace helpful homegrown CDS, 9 to disrupt safe dosing of pediatric medications, 10 to interfere with severe allergy alerts, 11 and to lower physician satisfaction with CDS. 12 We sought to apply the lessons from these studies and anticipated introducing alert governance before go-live would have twofold benefits.…”