| A framework for evaluating the appropriateness of clinical decision support alerts and responses. | |
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MedLine Citation:
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PMID: 21849334 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. METHODS: Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). RESULTS: Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. CONCLUSION: The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types. |
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Authors:
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Allison B McCoy; Lemuel R Waitman; Julia B Lewis; Julie A Wright; David P Choma; Randolph A Miller; Josh F Peterson |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2011-08-17 |
Journal Detail:
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Title: Journal of the American Medical Informatics Association : JAMIA Volume: 19 ISSN: 1527-974X ISO Abbreviation: J Am Med Inform Assoc Publication Date: 2012 May-Jun |
Date Detail:
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Created Date: 2012-04-11 Completed Date: 2012-08-20 Revised Date: 2013-06-03 |
Medline Journal Info:
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Nlm Unique ID: 9430800 Medline TA: J Am Med Inform Assoc Country: United States |
Other Details:
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Languages: eng Pagination: 346-52 Citation Subset: IM |
Affiliation:
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Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee 77030, USA. allison.b.mccoy@uth.tmc.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Kidney Injury
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prevention & control Decision Support Systems, Clinical* Drug Therapy, Computer-Assisted Electronic Health Records* Humans Medical Audit / methods* Medical Order Entry Systems* Medication Errors / prevention & control* Medication Systems, Hospital Models, Theoretical Reminder Systems Retrospective Studies Single-Blind Method Tennessee User-Computer Interface* |
| Grant Support | |
ID/Acronym/Agency:
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KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; R01 LM009965/LM/NLM NIH HHS; R01 LM009965/LM/NLM NIH HHS; R01 LM009965-03/LM/NLM NIH HHS; T15 LM007450/LM/NLM NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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