Clinical decision support (CDS) alerts for drug interactions need major improvements. A paper published at the Journal of the American Medical Informatics Association offers some recommendations.
The paper is based on conclusions made by the federal Usability Workgroup, which conducted a series of meetings over 13 months to develop specific recommendations to improve the quality of drug-drug interaction (DDI) decision support. Twenty-four clinical, usability and informatics experts took part in the meetings.
They recommend DDI alerts include seven components:
- Drugs involved
- Seriousness
- Clinical consequences
- Mechanism of the interaction
- Contextual information/modifying factors
- Recommended action
- Evidence
Because clinicians often work in multiple settings, the paper's authors recommend that alerts be presented consistently across different electronic health record systems to ease recognition and prompt action.
Alerts that interrupt workflow should be reserved for the most serious interactions, the paper states. Alerts should appear at the point of decision-making, not requiring the user to go back after an order is nearly complete. Instead, alerts should guide decision-making to relatively safer alternative options.
The general alert content should be consistent and available to the various members of the care team, but may be changed based on different members' roles, responsibilities and privileges, the report adds.
In their current form, override rates have limited capability to evaluate alert effectiveness, the authors say, suggesting that's not the best measure. Effectiveness has both measured value as well as perceived value, according to the paper. For example, medical residents may perceive high value if an alert reminds them to order an international normalized ratio, but practicing cardiologists may perceive little value in that.
Doctors are still learning how to integrate CDS systems into their workflow and are suffering from alert fatigue. In one study of 2 million CDS alerts relating to prescriptions, providers chose to override roughly half of them--and only about half of those overrides were appropriate.
In a tip sheet, the Centers for Medicare & Medicaid Services reminded users that pop-up alerts are not the only way to meet the Meaningful Use program's objective. It also can be met through other kinds of CDS, including clinical guidelines, condition-specific order sets, focused patient data reports and summaries and diagnostic support, among other options.
To learn more:
- read the paper