Study: EMRs get facelift with universal interface to support prescribers
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Published in the April edition of International Journal of Medical Informatics, Alissa L. Russ, PhD, research scientist with the Center of Excellence on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues observed providers as they treated patients to learn about the strengths and weaknesses of medication alerts generated by EMR systems. The researchers plan to use this information to improve the design of medication alerts and diminish alert fatigue.
Medication alerts provide the healthcare team with computer-generated information on a variety of drug-related issues. Among the most common medication alerts are warnings about patient allergies, drug interactions and duplicate prescriptions. The alerts, critical to patient safety, can be triggered by many factors including the prescription of a new medication or a change in a patient's laboratory test results.
But healthcare providers may experience alert fatigue and unintentionally overlook important alerts if the EMR system generates too many medication alerts; if alerts do not apply to the patient (for example, warning about a drug the patient has already been taking without problems); or if the alert provides too much extra information. The goal is to develop alerts that aid healthcare providers more effectively and enhance patient safety.
"Few studies have examined prescribers' interactions with medication alerts at the point of prescribing," the authors wrote. Conducting an in situ, human factor investigation of outpatient prescribing, 320 alerts generated by an EMR were observed among 30 prescribers and their interactions with 146 patients. Researchers collected 102.8 hours of combined observation and interview data, yielding 351 pages of typed notes.
The authors identified nine factors that influence prescribers as they encounter alerts, providing a detailed description of 44 components that contribute to these factors. The factors include:
- Alert system logic;
- Alert system redundancy;
- Alert content;
- Alert display;
- Cognitive factors;
- Pharmaceutical knowledge;
- Medication management;
- Workflow; and
- Alert system reliability.
"Prescribers’ ability to act on alerts was impeded by the alert interface, which did not adequately support all prescriber types," they wrote. The researchers found that prescribers were sometimes unsure why an alert was appearing, and they also determined that alert designs were more pharmacist-oriented than physician- or nurse practitioner-oriented, in spite of the fact that doctors and nurse practitioners were the principal prescribers.
Due to the results, Russ and colleagues recommended actions for alert designers, including:
- Expand alerts that leverage patient labs;
- Reduce alerts that contradict broadly accepted clinical practices;
- Design alert interfaces to support both pharmacist and nonpharmacist prescribers;
- Balance the strengths of computer automation and human cognition; and
- Prepare alert systems for increased EHR interoperability.
“Redesign efforts should include a more universal interface that supports a wider variety of prescribers,” the researchers concluded. “Findings may ultimately be used to enhance decision support for prescribers and medication safety for patients, and future studies should be directed towards conducting usability tests of alternative alert designs, to qualitatively and quantitatively evaluate prescribers’ interactions with alerts.”