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Thursday
Nov242011

EHR Alerts, Evidence, and Usability

The IOM's lengthy report on HIT and patient safety provides a nice overview of the evidence regarding clinical decision support (CDS) components of HIT systems (on pp 2-9 to 2-11).  The report discusses the relatively strong evidence for medication alerts and the somewhat lacking evidence for other types of CDS, and more importantly the underlying key to success:

 

When implementing an alert system, success depends on how alerts impact workflow (Bates et al., 2003). If implemented correctly, alerts can improve patient safety. Alerts have been demonstrated to lower the rate of inappropriate medication prescriptions to select vulnerable populations, such as the elderly (Raebel et al., 2007). Flag alerts — reminders of patient diagnosis or conditions to clinicians who access patient EHRs — have been demonstrated to improve longterm treatment and increase the likelihood of achieving treatment goals (Agostini et al., 2007Whitley et al., 2006). A retrospective analysis examining a diagnostic alarm system showed that the alarm system could detect and alert clinicians of critical events during anesthesia administration as effectively as anesthesiologists (Gohil et al., 2007).

 

Simply having an alert in the system doesn't ensure better care.  The same can probably be said of infobuttons and all other CDS features.  To work well, they need to be a seamless part of the clinical workflow.  This is, I think, important for us to keep in mind when we're engaged in conversations about integrating resources and evidence into EHRs.  Integration is important, but we want to make sure the evidence is integrated in a convenient and usable way.  

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