Electronic alerting system improves documentation of patient problems

Using an automatic alert system in providers' EHR systems "significantly" increases the documentation of previously unknown patient problems, which could potentially facilitate quality improvement.

That's the conclusion of a recent study published by the Journal of the American Medical Informatics Association. According to the study, which involved 28 clinics affiliated with a large academic medical center, patient problems were about three times more likely to be documented when providers received an alert. "This increase is clinically important, since many of these problems are used for quality improvement and clinical decision support," the study's authors reported.

Patient clinical problem lists are often inaccurate, incomplete or out of date, making it harder to treat the patient, especially when the provider is unfamiliar with the patient or the patient is in an inpatient setting.

Accurate problem lists are also an essential component of meeting Meaningful Use. To qualify for meaningful use under the EHR incentive programs, providers must maintain up-to-date problem lists of current and active diagnoses with 80 percent of patients having at least one problem recorded or an indication of no known problems.

The study's authors recommended that the industry find new tools to improve patient problem list documentation.

The researchers used data mining techniques to identify potential patient problems, reviewing billing diagnosis codes, lab results, medications and vital signs, and developed an electronic alert in the providers' EHR system when there appeared to be an undocumented problem for 17 conditions, including stroke, glaucoma, attention deficit hyperactivity disorder and breast cancer. The study generated more than 17,000 alerts, of which more than 41 percent were accepted by the provider.

The authors did note that the EHR system used in the study was conducted within one system, which developed the EMR. So results might not be generalizable and commercial products might not be as flexible when it comes to adding clinical alerts, the authors said.

To learn more:
- read the study