J Am Med Inform Assoc - Evaluation of medication alerts in electronic health records for compliance with human factors principles.

Tópicos

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Resumo

TRODUCTION: Increasing the adoption of electronic health records (EHRs) with integrated clinical decision support (CDS) is a key initiative of the current US healthcare administration. High over-ride rates of CDS alerts strongly limit these potential benefits. As a result, EHR designers aspire to improve alert design to achieve better acceptance rates. In this study, we evaluated drug-drug interaction (DDI) alerts generated in EHRs and compared them for compliance with human factors principles.METHODS: We utilized a previously validated questionnaire, the I-MeDeSA, to assess compliance with nine human factors principles of DDI alerts generated in 14 EHRs. Two reviewers independently assigned scores evaluating the human factors characteristics of each EHR. Rankings were assigned based on these scores and recommendations for appropriate alert design were derived.RESULTS: The 14 EHRs evaluated in this study received scores ranging from 8 to 18.33, with a maximum possible score of 26. Cohen's (=0.86) reflected excellent agreement among reviewers. The six vendor products tied for second and third place rankings, while the top system and bottom five systems were home-grown products. The most common weaknesses included the absence of characteristics such as alert prioritization, clear and concise alert messages indicating interacting drugs, actions for clinical management, and a statement indicating the consequences of over-riding the alert.CONCLUSIONS: We provided detailed analyses of the human factors principles which were assessed and described our recommendations for effective alert design. Future studies should assess whether adherence to these recommendations can improve alert acceptance.

Resumo Limpo

troduct increas adopt electron health record ehr integr clinic decis support cds key initi current us healthcar administr high overrid rate cds alert strong limit potenti benefit result ehr design aspir improv alert design achiev better accept rate studi evalu drugdrug interact ddi alert generat ehr compar complianc human factor principlesmethod util previous valid questionnair imedesa assess complianc nine human factor principl ddi alert generat ehr two review independ assign score evalu human factor characterist ehr rank assign base score recommend appropri alert design derivedresult ehr evalu studi receiv score rang maximum possibl score cohen reflect excel agreement among review six vendor product tie second third place rank top system bottom five system homegrown product common weak includ absenc characterist alert priorit clear concis alert messag indic interact drug action clinic manag statement indic consequ overrid alertconclus provid detail analys human factor principl assess describ recommend effect alert design futur studi assess whether adher recommend can improv alert accept

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