J Am Med Inform Assoc - Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors.

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Resumo

JECTIVE: Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems.DESIGN: A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task.MEASUREMENTS: The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems.RESULTS: Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04).CONCLUSIONS: Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes.

Resumo Limpo

jectiv expert author recommend clinic decis support system reduc prescrib error rate yet larg number insignific onscreen alert present modal dialog box persist interrupt clinician limit effect system studi compar impact modal nonmod electron e prescrib alert prescrib error rate help inform design clinic decis support systemsdesign random studi junior doctor perform simul prescrib task random order prototyp eprescrib system use withinparticip design doctor random shown one three type eprescrib alert modal nonmod alert prescrib taskmeasur main outcom measur prescrib error rate structur interview perform elicit particip prefer prescrib alert view clinic decis support systemsresult particip expos modal alert time less like make prescrib error shown alert ci shown nonmod alert time less like make prescrib error ci shown alert error rate nonmod alert time higher modal alert ci conclus kind eprescrib alert signific reduc prescrib error rate modal alert three time effect nonmod alert studi provid new evid relat effect modal nonmod alert prescrib outcom

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