Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems

John D. McGreevey III; Colleen P. Mallozzi; Randa M. Perkins; Eric Shelov; Richard Schreiber

doi:10.1055/s-0039-3402715

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2020; 11(01): 001-012
DOI: 10.1055/s-0039-3402715

AMIA CIC 2019

Georg Thieme Verlag KG Stuttgart · New York

Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems

John D. McGreevey III

¹Office of the CMIO, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States

²Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Colleen P. Mallozzi

¹Office of the CMIO, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States

,

Randa M. Perkins

³H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States

,

Eric Shelov

⁴Division of General Pediatrics, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

,

Richard Schreiber

⁵Physician Informatics and Department of Medicine, Geisinger Health System, Geisinger Holy Spirit, Camp Hill, Pennsylvania, United States

› Institutsangaben

Abstract

Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan.

Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts.

Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human–computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians.

Results The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship.

Conclusion Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.

Keywords

clinical decision support - alerting - alert fatigue - safety - governance

Volltext

Referenzen

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