On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop
1 University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB UK
2 College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2SP UK
3 West Midlands Centre for Adverse Drug Reactions, City Hospital, Dudley Road, Birmingham B18 7QH UK
4 Erasmus University Medical Centre, Department of Hospital Pharmacy, PO Box 2040, 3000 CA Rotterdam, Netherlands
5 Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
6 School of Medicine Pharmacy and Health, The University of Durham, Durham TS17 6BH UK
7 Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA 02120 USA
8 Harvard Medical School, Boston, MA 02115 USA
9 Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm 14186 Sweden
10 Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
11 Institute of Health Informatics, UMIT – University of Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum I, 6060 Hall in Tirol, Austria
BMC Medical Informatics and Decision Making 2013, 13:111 doi:10.1186/1472-6947-13-111Published: 1 October 2013
Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority.
A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop.
We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures.
We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.