Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals

Abstract

Objective To identify and summarize the current internal governance processes adopted by hospitals, as reported in the literature, for selecting, optimizing, and evaluating clinical decision support (CDS) alerts in order to identify effective approaches. Materials and methods Databases (Medline, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore Digital Library, CADTH, and WorldCat) were searched to identify relevant papers published from January 2010 to April 2020. All paper types published in English that reported governance processes for selecting and/or optimizing CDS alerts in hospitals were included. Results Eight papers were included in the review. Seven papers focused specifically on medication-related CDS alerts. All papers described the use of a multidisciplinary committee to optimize alerts. Other strategies included the use of clinician feedback, alert data, literature and drug references, and a visual dashboard. Six of the 8 papers reported evaluations of their CDS alert modifications following the adoption of optimization strategies, and of these, 5 reported a reduction in alert rate. Conclusions A multidisciplinary committee, often in combination with other approaches, was the most frequent strategy reported by hospitals to optimize their CDS alerts. Due to the limited number of published processes, variation in system changes, and evaluation results, we were unable to compare the effectiveness of different strategies, although employing multiple strategies appears to be an effective approach for reducing CDS alert numbers. We recommend hospitals report on descriptions and evaluations of governance processes to enable identification of effective strategies for optimization of CDS alerts in hospitals.

Modulators Influencing Medication Alert Acceptance: An Explorative Review

“…After the removal of 110 duplicates and the exclusion of 276 articles following title and abstract screening, a total of 153 full texts were read. In compliance with the inclusion and exclusion criteria, 31 articles reporting quantitative and qualitative parameters 13 33 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 and 29 articles reporting exclusively qualitative parameters of alert acceptance 1 6 12 17 32 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 were included in the analysis.…”

“…The inclusion of the stakeholder's perspectives and continuous quality assurance and improvement of alerts together with interdisciplinary expert panels showed positive signals for alert optimization thus contributing to better acceptance. 23 However, factors such as alert content or alert specificity are mentioned frequently, but due to the lack of an impossible “one-size-fits-all” approach, specific alerts are still rare. 12…”

A review of electronic medical records and safe transfusion practice for guideline development

“…Setting alert levels to draw attention to appropriate risks may be difficult. There is no standardized approach, and it requires ongoing review [34]. For example, in medication prescribing, theoretical drug interaction alerts based on pharmacopoeia‐reported interactions are common even with combinations that are known to be safe.…”

“…There is an advantage in electronic systems being able to detect potential errors or risks and alert the user; however, excessive alerts may lead to staff dismissing these as routine [33,34]. Importantly, the alerts do not have to relate to transfusion processes to induce reduced attention to issues during the transfusion process.…”

Evaluating a Prototype Clinical Decision Support Tool for Chronic Pain Treatment in Primary Care

“…[1][2][3][4] Computerized clinical decision support can facilitate user interaction with these data to visualize trends and prompt clinical action. [5][6][7][8] Yet, the proliferation of EHRs and electronic clinical information has also led some to describe the information environment in primary care settings as "chaotic" and potentially harmful to clinician decision making and stress levels. [9][10][11] Accordingly, innovations are needed to improve clinicians' experiences and patient information management when using EHRs, including when caring for chronic health conditions, such as chronic noncancer pain.…”