Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record.
Reduced Effectiveness of Interruptive Drug-Drug Interaction Alerts after Conversion to a Commercial Electronic Health Record.
复制标题
转换为商业电子健康记录后，中断性药物相互作用警报的有效性降低。
DOI：
10.1007/s11606-018-4415-9
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发表时间：
2018
影响因子：
5.7
通讯作者：
Bates,DavidW
中科院分区：
文献类型：
--
作者：
Wright,Adam;Aaron,Skye;Seger,DianeL;Samal,Lipika;Schiff,GordonD;Bates,DavidW
电子健康记录（EHR）中的药物相互作用（DDI）警报可以帮助预防药物不良事件，但此类警报经常被覆盖，目的研究转换为商业EHR对DDI警报和接受率的影响。经过研究，3277名在门诊接受DDI警报的临床医生，商业电子健康记录及随后的DDI警报标准调整。主要措施警报负担和接受警报的比例。关键结果总体从传统EHR到商业EHR，中断DDI警报负担增加了6倍。最严重警报的接受率从100%下降到8.4%，中等严重警报的接受率从29.3%下降到7.5%（P< 0.001）。禁用最不严重的警报后，总DDI警报负担下降了50.5%，并接受第1层警报上升到12.7%（P< 0.01）。ConclusionsChanging从一个高度定制的DDI警报系统，以更一般的一部分，EHR转换减少DDI警报的接受和增加用户的警报负担。接受率的下降不能完全由临床知识库的差异来解释，也不能完全由与警报负担增加相关的警报疲劳来解释。相反，工作流程因素可能占主导地位，包括处方过程中的警报时间，缺乏区分更严重和不太严重的警报，以及用户如何与警报交互的功能。
BackgroundDrug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue.ObjectiveTo study the effect of conversion to a commercial EHR on DDI alert and acceptance rates.DesignTwo before-and-after studies.Participants3277 clinicians who received a DDI alert in the outpatient setting.InterventionIntroduction of a new, commercial EHR and subsequent adjustment of DDI alerting criteria.Main MeasuresAlert burden and proportion of alerts accepted.Key ResultsOverall interruptive DDI alert burden increased by a factor of 6 from the legacy EHR to the commercial EHR. The acceptance rate for the most severe alerts fell from 100 to 8.4%, and from 29.3 to 7.5% for medium severity alerts (P< 0.001). After disabling the least severe alerts, total DDI alert burden fell by 50.5%, and acceptance of Tier 1 alerts rose from 9.1 to 12.7% (P< 0.01).ConclusionsChanging from a highly tailored DDI alerting system to a more general one as part of an EHR conversion decreased acceptance of DDI alerts and increased alert burden on users. The decrease in acceptance rates cannot be fully explained by differences in the clinical knowledge base, nor can it be fully explained by alert fatigue associated with increased alert burden. Instead, workflow factors probably predominate, including timing of alerts in the prescribing process, lack of differentiation of more and less severe alerts, and features of how users interact with alerts.