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Some Methods For Improving EMR Alerts

Posted on June 25, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study appearing in the Journal of the American Medical Informatics Association has made some points that may turn out to be helpful in designing those pesky but helpful alerts for clinicians.

Making alerts useful and appropriate is no small matter. As we reported on a couple of years ago, even then EMR alert fatigue has become a major source of possible medical errors. In fact, a Pediatrics study published around that time found that clinicians were ignoring or overriding many alerts in an effort to stay focused.

Despite warnings from researchers and important industry voices like The Joint Commission, little has changed since then. But the issue can’t be ignored forever, as it’s a car crash waiting to happen.

The JAMIA study may offer some help, however. While it focuses on making drug-drug interaction warnings more usable, the principles it offers can serve as a model for designing other alerts as well.

For what it’s worth, the strategies I’m about to present came from a DDI Clinical Decision Support conference attended by experts from ONC, health IT vendors, academia and healthcare organizations.

While the experts offered several recommendations applying specifically to DDI alerts, their suggestions for presenting such alerts seem to apply to a wide range of notifications available across virtually all EMRs. These suggestions include:

  • Consistent use of color and visual cues: Like road signs, alerts should come in a limited and predictable variety of colors and styles, and use only color and symbols for which the meaning is clear to all clinicians.
  • Consistent use of terminology and brevity: Alerts should be consistently phrased and use the same terms across platforms. They should also be presented concisely, with minimal text, allowing for larger font sizes to improve readability.
  • Avoid interruptions wherever possible:  Rather than freezing clinician workflow over actions already taken, save interruptive alerts that require action to proceed for the most serious situation. The system should proactively guide decisions to safer alernatives, taking away the need for interruption.

The research also offers input on where and when to display alerts.

Where to display alert information:  The most critical information should be displayed on the alert’s top-level screen, with links to evidence — rather than long text — to back up the alert justification.

When to display alerts: The group concluded that alerts should be displayed at the point when a decision is being made, rather than jumping on the physician later.

The paper offers a great deal of additional information, and if you’re at all involved in addressing alerting issues or designing the alerts I strongly suggest you review the entire paper.

But even the excerpts above offer a lot to consider. If most alerts met these usability and presentation standards, they might offer more value to clinicians and greater safety to patients.

Pediatricians Find EMRs Lacking

Posted on December 10, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While there’s no lack of specialty EMRs out there, it seems that pediatricians feel undeserved anyway. In fact, a new study suggests that there are five functions pediatricians look for in EMRs which are seldom found in a single system.

Almost half of pediatricians have adopted EMRs (48.5 percent), and 61.7 percent of doctors in internal medicine/pediatrics, according to a report in American Medical News.  (The data was drawn from marketing research firm SK&A, which does ongoing surveys on EMR adoption and use at 250,000-odd practices nationwide.)

The study, which appears in this month’s issue of the journal  Pediatrics, reports on a random survey of 646 postresidency pediatricians done in 2009 before the MU incentive program began. At the time, only 3 percent were using an EMR that they considered fully-functional and supportive of their specialty.

The authors say that pediatricians need five key features in place to consider an EMR complete. These include tracking of well-child visits, support of growth chart analysis, immunization tracking, immunization forecasting and weight-based drug dosing. Unfortunately, Meaningful Use standards  are nowhere near addressing the entire bundle of functions, they note.

So, are there any solutions for pediatricians which have emerged since the study survey was done? Certainly, there are scads of EMRs out there being marketed as pediatric EMRs. However, at first glance at least, most of the market for pediatric EMR solutions seems to be general  purpose systems offering pediatrics-specific templates.

On the horizon, however, there may be a glimmer of hope. Apparently, the Agency for Healthcare Quality and Research has designed a model children’s EMR which includes a list of child-specific functions, and ONC anticipates including these features in future stages of the EMR certification criteria.

In the mean time, it looks like pediatricians face the need to either work with (arguably) inefficient systems or customize systems on their own. Neither possibility would sound good if you were a pediatrician, would it?