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CC BY 4.0 · Appl Clin Inform
DOI: 10.1055/a-2554-3969
Research Article

User Actions Within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease

Lipika Samal
1   Medicine, Brigham and Women's Hospital, Boston, United States
2   Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
,
Sarah W Chen
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Stuart Lipsitz
1   Medicine, Brigham and Women's Hospital, Boston, United States
2   Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
3   Harvard T H Chan School of Public Health, Boston, United States (Ringgold ID: RIN1857)
,
Heather J Baer
1   Medicine, Brigham and Women's Hospital, Boston, United States
2   Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
3   Harvard T H Chan School of Public Health, Boston, United States (Ringgold ID: RIN1857)
,
John L Kilgallon
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)
5   Hackensack Meridian School of Medicine, Nutley, United States (Ringgold ID: RIN576909)
,
Michael P Gannon
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)
6   Eastern Virginia Medical School, Norfolk, United States (Ringgold ID: RIN6040)
,
Ryan Dunk
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Weng Ian Chay
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Richard Fay
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Michael Sainlaire
7   Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)
,
Chenxi Gao
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Matthew Wien
1   Medicine, Brigham and Women's Hospital, Boston, United States
,
Pamela Garabedian
8   Medicine, Mass General Brigham Inc, Boston, United States (Ringgold ID: RIN1813)
,
Edward Wu
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, United States (Ringgold ID: RIN1861)
9   Alabama College of Osteopathic Medicine, Dothan, United States (Ringgold ID: RIN376598)
,
Hojjat Salmasian
10   The Children's Hospital of Philadelphia, Philadelphia, United States (Ringgold ID: RIN6567)
,
David W. Bates
1   Medicine, Brigham and Women's Hospital, Boston, United States
2   Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
,
Patricia Dykes
11   General Internal Medicine, Brigham and Women's Hospital Department of Medicine, Boston, United States (Ringgold ID: RIN370908)
2   Harvard Medical School, Boston, United States (Ringgold ID: RIN1811)
,
Adam Wright
12   Biomedical Informatics, Vanderbilt University, Nashville, United States (Ringgold ID: RIN5718)
,
Allison B McCoy
12   Biomedical Informatics, Vanderbilt University, Nashville, United States (Ringgold ID: RIN5718)
› Author AffiliationsSupported by: National Institute of Diabetes and Digestive and Kidney Diseases 5R01DK116898

Clinical Trial: Registration number (trial ID): NCT03679247, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Secondary Subgroup Analysis of RCT
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Objective: To examine user actions within a clinical decision support (CDS) alert addressing hypertension (HTN) in chronic kidney disease (CKD). Methods: A pragmatic randomized controlled trial of a CDS alert for primary care patients with CKD and uncontrolled blood pressure included pre-checked default orders for medication initiation or titration, basic metabolic panel (BMP), and nephrology electronic consult. We examined each type of action and calculated percentages of placed and signed orders for subgroups of firings. Results: There were firings for medication initiation (813) and medication titration (430), and every firing also included orders for nephrology electronic consult (1243) and BMP (1243). High rates of override (59.6%) and deferral (14.6%) were observed, and CDS-recommended orders were only signed about one-third of the time from within the alert. The percentage of orders that were signed after being placed within the alert was higher for medication initiation than for medication titration (33% vs 12.0% for angiotensin-converting enzyme inhibitors (ACEi), 38.8% vs 14% for angiotensin II receptor blockers (ARB). Discussion: Findings suggest that users are hesitant to commit to immediate action within the alert. Conclusion: Evaluating user interaction within alerts reveals nuances in physician preferences and workflow that should inform CDS alert design.



Publication History

Received: 31 May 2024

Accepted after revision: 19 December 2024

Accepted Manuscript online:
17 March 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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