Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare

Gaikwad, Rekha; Sketris, Ingrid; Shepherd, Michael; Duffy, Jack

doi:10.1177/1460458207079836

Cited by 37 publications

(16 citation statements)

References 13 publications

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“…Our results support international literature in this area. Studies have shown variation and deficiencies in drug interaction decision support in pharmacy software systems in the United States, 22 in clinical software systems used in primary care in Canada, 23 and in drug interaction software for personal digital assistants 20 , 21 . A study of German GPs found that they wanted detailed drug interaction information, but their needs were not being met for some components (eg, management of interactions, outcomes) 24 …”

Section: Discussionmentioning

confidence: 99%

Quality of drug interaction alerts in prescribing and dispensing software

Sweidan¹,

Reeve²,

Brien

et al. 2009

Medical Journal of Australia

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Objective: To investigate the quality of drug interaction decision support in selected prescribing and dispensing software systems, and to compare this information with that found in a range of reference sources. Design and setting: A comparative study, conducted between June 2006 and February 2007, of the support provided for making decisions about 20 major and 20 minor drug interactions in six prescribing and three dispensing software systems used in primary care in Australia. Five electronic reference sources were evaluated for comparison. Main outcome measures: Sensitivity, specificity and quality of information; for major interactions: whether information on clinical effects, timeframe and pharmacological mechanism was included, whether management advice was helpful, and succinctness. Results: Six of the nine software systems had a sensitivity rate ≥ 90%, detecting most of the major interactions. Only 3/9 systems had a specificity rate of ≥ 80%, with other systems providing inappropriate or unhelpful alerts for many minor interactions. Only 2/9 systems provided adequate information about clinical effects for more than half the major drug interactions, and 1/9 provided useful management advice for more than half of these. The reference sources had high sensitivity and in general provided more comprehensive clinical information than the software systems. Conclusions: Drug interaction decision support in commonly used prescribing and dispensing software has significant shortcomings.

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Section: Discussionmentioning

confidence: 99%

Quality of drug interaction alerts in prescribing and dispensing software

Sweidan¹,

Reeve²,

Brien

et al. 2009

Medical Journal of Australia

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“…Clearly, the misuse, disuse, and abuse of automation are important human factors and ergonomics topics (Parasuraman and Riley, 1997). Evidence about why CDS is ignored or overridden is similar to what has been found studying automation in other domains-the research on CDS has identified low specificity, low sensitivity, unclear information content, unnecessary workflow disruptions, and poor usability all as contributing factors (Miller et al, 2005;Saleem et al, 2005;Gaikwad et al, 2007). In fact, in a paper titled "Grand Challenges in Clinical Decision Support" (Sittig et al, 2008) 10 grand challenges for CDS were posed, and the #1 ranked challenge was improving the human-computer interface.…”

Section: Cds Human Factors and Ergonomics Issuesmentioning

confidence: 73%

Assessment and Evaluation Tools for Health-Care Ergonomics: Musculoskeletal Disorders and Patient Handling

Hignett¹,

Fray²,

Matz³

2016

Handbook of Human Factors and Ergonomics in Health Care and Patient Safety

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“…15,16 At the very least, poor implementation of eCDS systems leads to wasted effort and money by failing to accomplish its goal. 17,18 At worst, it leads to unnecessary patient morbidity or mortality by serving as a time-consuming distraction to physicians. 19,20 …”

mentioning

confidence: 99%

Designing Real‐time Decision Support for Trauma Resuscitations

Yadav

Chamberlain

Lewis³

et al. 2015

Academic Emergency Medicine

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Background Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. Objectives The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. Methods This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the evaluations performed to ensure all concerns were identified and addressed. Results Among 26 EPs (76% response rate), the main barriers to using the existing tool were that the information displayed is redundant and does not fit clinical workflow. After the prototype eCDS tool was developed based on the trauma resuscitation hierarchical task analysis, the human factors engineers rated it to be better than the CPOE tool for nine of 10 standard user interface design heuristics on a three-point scale. The eCDS tool was also rated better for clinical use on the same scale, in 84% of 50 expert–video pairs, and was rated equivalent in the remainder. Clinical experts also rated barriers to use of the eCDS tool as being low. Conclusions An eCDS tool for diagnostic imaging designed using human factors engineering methods has improved perceived usability among pediatric emergency physicians.

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Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare

Cited by 37 publications

References 13 publications

Quality of drug interaction alerts in prescribing and dispensing software

Quality of drug interaction alerts in prescribing and dispensing software

Assessment and Evaluation Tools for Health-Care Ergonomics: Musculoskeletal Disorders and Patient Handling

Designing Real‐time Decision Support for Trauma Resuscitations

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