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Appl Clin Inform 2021; 12(05): 1144-1149
DOI: 10.1055/s-0041-1740257
Research Article

Low Efficacy of Medication Shortage Clinical Decision Support Alerts

Nicole M. Benson
1   McLean Hospital, Belmont, Massachusetts, United States
2   Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States
3   Harvard Medical School, Boston, Massachusetts, United States
,
Caryn Belisle
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
David W. Bates
3   Harvard Medical School, Boston, Massachusetts, United States
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
5   Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
,
Hojjat Salmasian
3   Harvard Medical School, Boston, Massachusetts, United States
4   Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
› Author Affiliations Funding N.M.B. received support from the National Library of Medicine Biomedical Informatics and Data Science Research Training Grant (BIRT) T15 LM007092.
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Abstract

Objective We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations.

Materials and Methods We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alternative medication suggestion and were active for 60 or more days during the 2-year study period, January 1, 2018 to December 31, 2019, in a large health care system. We characterized ordering provider behavior in response to inpatient MSAs. We then developed a linear regression model to predict provider response to alerts using the characteristics of the ordering provider and alert frequency groupings.

Results During the study period, there were 67 MSAs in use that focused on 42 distinct medications in shortage. The MSAs suggested an average of 3.9 alternative medications. Adjusting for the different alerts, fellows (p = 0.004), residents (p = 0.03), and physician assistants (p = 0.02) were less likely to accept alerts on average compared with attending physicians. Further, female ordering clinicians (p < 0.001) were more likely to accept alerts on average compared with male ordering clinicians.

Conclusion Our findings demonstrate that providers tended to reject MSAs, even those who were sometimes flexible about their responses. The low overall acceptance rate supports the theory that alerts appearing at the time of order entry may have limited value, as they may be presented too late in the decision-making process. Though MSAs are designed to be attention-grabbing and higher impact than traditional CDS, our findings suggest that providers rarely change their clinical decisions when presented with these alerts.

Keywords

medication shortage - quality of care - cost of care - electronic health records

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the Mass General Brigham Institutional Review Board.


Supplementary Material



Publication History

Received: 23 June 2021

Accepted: 20 October 2021

Article published online:
01 December 2021

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