The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review

Olakotan, Olufisayo; Yusof, Maryati Mohd.

doi:10.1177/14604582211007536

Cited by 32 publications

(33 citation statements)

References 107 publications

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“…121 Some studies (n = 10) mentioned 'alert fatigue' indicating that eCDS tools designed to support health professionals can increase the number of on-screen alerts, leading to a high chance of them being missed or ignored. 15,35,38,97,112,117,[122][123][124][125] None of these studies reported a decrease in consultation duration.…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 95%

“…98,104,111 Two articles that referred to the same core UK study, described capturing duration data from the practice IT system (Vision), based on the opening and closing of the EMR. 95,103 One USA study estimated consultation duration based on the reasons patients were attending -either for a 'shorter' visit, such as for acute care or follow-up, or for a 'longer' visit, such as for a general medical examination 96 , and two studies provided insu cient details of the methods used 92,112 .…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

“…A systematic review that examined factors in uencing the appropriateness of interruptive alerts found such alerts increased cognitive weariness, and that an 'overload' of alerts increased mental workload. 112 A study of an eCDS tool for assessing cardiovascular risk also highlighted clinicians' concerns about the cognitive burden of changing to a new way of calculating risk compared with the conventional method they had used until that point. 126 One study reported workload expressed as the number of follow-up consultations needed.…”

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

“…49 The usual ow of tasks to complete during a consultation (often referred to as 'work ow' 31,[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] ) was commonly expected to be disrupted by eCDS tools, causing an increase in consultation duration. 28,31,33,36,50,[65][66][67] Speci c time-consuming functions of tools, such as reading text, additional data-entry and using tools which were stand-alone from the EMR 16,36,41,46,65,[68][69][70] , as well as perceptions of poor-or slow-functioning software 45,50,67,71 were also highlighted. A potential for negative impact of eCDS tools on the trajectory of the conversation with patients was expressed by some health professionals.…”

Section: Perceived Increase In Consultation Durationmentioning

confidence: 99%

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Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Fletcher

Burns

Wiering

et al. 2022

Preprint

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Background: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.Methods: A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.Results: The search resulted in 5,594 references, leading to 91 full articles after screening. Of these, 33 studies were based in the USA, 20 in the UK and 11 in Australia. A further 22 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.Conclusions: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

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Section: Methods To Measure Consultation Durationmentioning

confidence: 95%

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

Section: Methods To Measure Consultation Durationmentioning

confidence: 99%

Section: Perceived Increase In Consultation Durationmentioning

confidence: 99%

See 2 more Smart Citations

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Fletcher

Burns

Wiering

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…A suboptimal design would lead to alerts being overridden, ignored or misinterpreted and can disrupt workflow, resulting in increases in consultation time, cognitive load and physical fatigue. 16 Successful development and implementation will depend on partnerships between clinicians, researchers, guideline developers and the medical software industry, so that any tools that are developed incorporate guidelines that are endorsed and trusted in a way that optimises usability in practice.…”

mentioning

confidence: 99%

Editorial: Guidelines - innovation needed to overcome barriers to use

Manski‐Nankervis¹

2022

Aust Prescr

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Electronic Health Record–Based Screening for Intimate Partner Violence

Lenert,

Rheingold,

Simpson

et al. 2024

JAMA Netw Open

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ImportanceIntimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated.ObjectiveTo assess the effect of an electronic health record (EHR)–based multifactorial intervention screening on the detection of IPV risk in primary care practice.Design, Setting, and ParticipantsThis cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.InterventionA noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.Main Outcomes and MeasuresThe main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.ResultsThe study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P &lt; .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).Conclusions and RelevanceThe intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.Trial RegistrationClinicalTrials.gov Identifier: NCT06284148

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The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review

Cited by 32 publications

References 107 publications

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Workload And Workflow Implications Associated With The Use Of Electronic Clinical Decision Support Tools Used By Health Professionals In General Practice: A Scoping Review

Editorial: Guidelines - innovation needed to overcome barriers to use

Electronic Health Record–Based Screening for Intimate Partner Violence

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