Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records
Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records
复制标题
DOI：
10.1136/amiajnl-2012-001089
复制
发表时间：
2013-05-01
影响因子：
6.4
通讯作者：
Bates-, David W.
中科院分区：
文献类型：
--
作者：
Phansalkar, Shobha;van der Sijs, Heleen;Bates-, David W.
目标 警报疲劳是与电子健康记录 (EHR) 中的临床决策支持系统的使用相关的常见问题。这个问题在药物相互作用 (DDI) 警报中尤为严重，研究报告其覆盖率约为 90%。本研究的目的是报告 DDI 专家小组基于共识的建议，这些建议可以安全地不中断 EHR 中提供商的工作流程，以减少警报疲劳。方法我们利用专家小组流程对交互进行评级。小组成员拥有医学、药学、药理学和临床信息学方面的专业知识，代表学术机构以及药物知识库和电子病历的供应商。此外，美国食品和药物管理局以及美国卫生系统药学协会的代表也参与了讨论。 结果 专家组的建议和考虑最终创建了 33 个基于类别的低优先级 DDI 列表，这些 DDI 不保证在 EHR 中发出中断警报。在一个机构中，这些占所显示交互的 36%。 讨论 驱动 DDI 警报的药物知识库内容的开发和定制是一项资源密集型任务。创建低优先级 DDI 的标准化列表可能有助于减少 EHR 中的警报疲劳。 结论 未来的努力可能包括开发一个联盟来随着时间的推移维护该列表。这样的清单还可以与电子病历中采用的经济激励措施结合使用。
Objective Alert fatigue represents a common problem associated with the use of clinical decision support systems in electronic health records (EHR). This problem is particularly profound with drug-drug interaction (DDI) alerts for which studies have reported override rates of approximately 90%. The objective of this study is to report consensus-based recommendations of an expert panel on DDI that can be safely made non-interruptive to the provider's workflow, in EHR, in an attempt to reduce alert fatigue.Methods We utilized an expert panel process to rate the interactions. Panelists had expertise in medicine, pharmacy, pharmacology and clinical informatics, and represented both academic institutions and vendors of medication knowledge bases and EHR. In addition, representatives from the US Food and Drug Administration and the American Society of Health-System Pharmacy contributed to the discussions.Results Recommendations and considerations of the panel resulted in the creation of a list of 33 class-based low-priority DDI that do not warrant being interruptive alerts in EHR. In one institution, these accounted for 36% of the interactions displayed.Discussion Development and customization of the content of medication knowledge bases that drive DDI alerting represents a resource-intensive task. Creation of a standardized list of low-priority DDI may help reduce alert fatigue across EHR.Conclusions Future efforts might include the development of a consortium to maintain this list over time. Such a list could also be used in conjunction with financial incentives tied to its adoption in EHR.