Abstract:Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan.
Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts.
Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institut… Show more
“…44 Organizations may want to consider upgrading their efforts to detect errors, recognizing that EHR-related error detection remains a vexing problem even during normal operations and especially around the time of EHR-to-EHR transitions. 45,46 Moving from one to another EHR may highlight unique contrasts between the systems. Partners health care transitioned from their homegrown system to a commercial vendor product resulting in markedly reduced effectiveness of drug-drug interaction (DDI) alerting.…”
Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery.
Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions.
Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation.
Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout.
Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.
“…44 Organizations may want to consider upgrading their efforts to detect errors, recognizing that EHR-related error detection remains a vexing problem even during normal operations and especially around the time of EHR-to-EHR transitions. 45,46 Moving from one to another EHR may highlight unique contrasts between the systems. Partners health care transitioned from their homegrown system to a commercial vendor product resulting in markedly reduced effectiveness of drug-drug interaction (DDI) alerting.…”
Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery.
Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions.
Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation.
Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout.
Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.
“…8 Another must-read is McGreevey et al's paper, "Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems," which describes the risks of alert fatigue that lead to feelings of burnout and presents actionable recommendations from four clinical informatics leaders from diverse health care organizations. 9 Lomotan et al's paper, "To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support," describes how the use of the Agency for Healthcare Research & Quality's CDS-Connect can provide a platform for peer-to-peer sharing of CDS tools.…”
“…These types of errors could lead CDS to fire in cases where it should not, or not fire in cases where it should, which could lead users to make an error (or omission) that could lead to patient harm 9,24 and contribute to alert fatigue. 25,26 We developed a portable, effective software tool to identify these classes of logic errors. The results are easily interpretable and actionable.…”
Objective Clinical decision support (CDS) can contribute to quality and safety. Prior work has shown that errors in CDS systems are common and can lead to unintended consequences. Many CDS systems use Boolean logic, which can be difficult for CDS analysts to specify accurately. We set out to determine the prevalence of certain types of Boolean logic errors in CDS statements.
Methods Nine health care organizations extracted Boolean logic statements from their Epic electronic health record (EHR). We developed an open-source software tool, which implemented the Espresso logic minimization algorithm, to identify three classes of logic errors.
Results Participating organizations submitted 260,698 logic statements, of which 44,890 were minimized by Espresso. We found errors in 209 of them. Every participating organization had at least two errors, and all organizations reported that they would act on the feedback.
Discussion An automated algorithm can readily detect specific categories of Boolean CDS logic errors. These errors represent a minority of CDS errors, but very likely require correction to avoid patient safety issues. This process found only a few errors at each site, but the problem appears to be widespread, affecting all participating organizations.
Conclusion Both CDS implementers and EHR vendors should consider implementing similar algorithms as part of the CDS authoring process to reduce the number of errors in their CDS interventions.
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