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Appl Clin Inform 2013; 04(01): 144-152
DOI: 10.4338/ACI-2012-12-RA-0055
Research Article
Schattauer GmbH

Provider Use of and Attitudes Towards an Active Clinical Alert

A Case Study in Decision Support
J. Feblowitz
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
3   Harvard Medical School, Boston, MA, USA
,
S. Henkin
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
,
J. Pang
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
,
H. Ramelson
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
3   Harvard Medical School, Boston, MA, USA
,
L. Schneider
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
3   Harvard Medical School, Boston, MA, USA
,
F. L. Maloney
2   Partners HealthCare, Boston, MA, USA
,
A. R. Wilcox
4   University of Louisville School of Medicine, Louisville, KY
,
D.W. Bates
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
3   Harvard Medical School, Boston, MA, USA
5   Department of Health Policy and Management, Harvard School of Public Health, Boston, MA
,
A. Wright
1   Division of General Internal Medicine, Brigham & Women’s Hospital, Boston, MA, USA
2   Partners HealthCare, Boston, MA, USA
3   Harvard Medical School, Boston, MA, USA
› Author Affiliations
Further Information

Publication History

received: 26 December 2012

accepted: 12 March 2013

Publication Date:
19 December 2017 (online)

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Summary

Background: In a previous study, we reported on a successful clinical decision support (CDS) intervention designed to improve electronic problem list accuracy, but did not study variability of provider response to the intervention or provider attitudes towards it. The alert system accurately predicted missing problem list items based on health data captured in a patient’s electronic medical record.

Objective: To assess provider attitudes towards a rule-based CDS alert system as well as heterogeneity of acceptance rates across providers.

Methods: We conducted a by-provider analysis of alert logs from the previous study. In addition, we assessed provider opinions of the intervention via an email survey of providers who received the alerts (n = 140).

Results: Although the alert acceptance rate was 38.1%, individual provider acceptance rates varied widely, with an interquartile range (IQR) of 14.8%-54.4%, and many outliers accepting none or nearly all of the alerts they received. No demographic variables, including degree, gender, age, assigned clinic, medical school or graduation year predicted acceptance rates. Providers’ self-reported acceptance rate and perceived alert frequency were only moderately correlated with actual acceptance rates and alert frequency.

Conclusions: Acceptance of this CDS intervention among providers was highly variable but this heterogeneity is not explained by measured demographic factors, suggesting that alert acceptance is a complex and individual phenomenon. Furthermore, providers’ self-reports of their use of the CDS alerting system correlated only modestly with logged usage.

Citation: Feblowitz J, Henkin S, Pang J, Ramelson H, Schneider L, Maloney FL, Wilcox AR, Bates DW, Wright A. Provider use of and attitudes towards an active clinical alert. A case study in decision support. Appl Clin Inf 2013; 4: 144–152

http://dx.doi.org/10.4338/ACI-2012-12-RA-0055

Keywords

Patient problem list - electronic medical records - primary care

 

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