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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2011

Open Access 01-12-2011 | Research article

Development of a context model to prioritize drug safety alerts in CPOE systems

Authors: Daniel Riedmann, Martin Jung, Werner O Hackl, Wolf Stühlinger, Heleen van der Sijs, Elske Ammenwerth

Published in: BMC Medical Informatics and Decision Making | Issue 1/2011

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Abstract

Background

Computerized physician order entry systems (CPOE) can reduce the number of medication errors and adverse drug events (ADEs) in healthcare institutions. Unfortunately, they tend to produce a large number of partly irrelevant alerts, in turn leading to alert overload and causing alert fatigue. The objective of this work is to identify factors that can be used to prioritize and present alerts depending on the 'context' of a clinical situation.

Methods

We used a combination of literature searches and expert interviews to identify and validate the possible context factors. The internal validation of the context factors was performed by calculating the inter-rater agreement of two researcher's classification of 33 relevant articles.

Results

We developed a context model containing 20 factors. We grouped these context factors into three categories: characteristics of the patient or case (e.g. clinical status of the patient); characteristics of the organizational unit or user (e.g. professional experience of the user); and alert characteristics (e.g. severity of the effect). The internal validation resulted in nearly perfect agreement (Cohen's Kappa value of 0.97).

Conclusion

To our knowledge, this is the first structured attempt to develop a comprehensive context model for prioritizing drug safety alerts in CPOE systems. The outcome of this work can be used to develop future tailored drug safety alerting in CPOE systems.
Appendix
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Literature
1.
Byers JF, White SV: Patient safety: principles and practice. 2004, New York, NY: Springer
2.
Institute of Medicine - Committee on Identifying and Preventing Medication Errors: Preventing medication errors. Edited by: Aspden P, Wolcott JA, Bootman JL, Cronenwett LR. 2007, Washington, DC: National Academies Press
3.
4.
5.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D: Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995, 274 (1): 29-34.
6.
Benkirane RR, Abouqal R, Haimeur CC, SS SECEK, Azzouzi AA, M'Daghri Alaoui AA: Incidence of adverse drug events and medication errors in intensive care units: a prospective multicenter study. J Patient Saf. 2009, 5 (1): 16-22. 10.1097/PTS.0b013e3181990d51.CrossRefPubMed
7.
Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO: Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc. 2009, 16 (5): 613-23. 10.1197/jamia.M3050.CrossRefPubMedPubMedCentral
8.
Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U: The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008, 15 (5): 585-600. 10.1197/jamia.M2667.CrossRefPubMedPubMedCentral
9.
Hug BL, Witkowski DJ, Sox CM, Keohane CA, Seger DL, Yoon C: Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention. J Gen Intern Med. 2010, 25 (1): 31-8. 10.1007/s11606-009-1141-3.CrossRefPubMed
10.
van Doormaal JE, van den Bemt PM, Zaal RJ, Egberts AC, Lenderink BW, Kosterink JG: The influence that electronic prescribing has on medication errors and preventable adverse drug events: an interrupted time-series study. J Am Med Inform Assoc. 2009, 16 (6): 816-25. 10.1197/jamia.M3099.CrossRefPubMedPubMedCentral
11.
Kuperman GJ, Bobb A, Payne TH, Avery AJ, Gandhi TK, Burns G: Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007, 14 (1): 29-40.CrossRefPubMedPubMedCentral
12.
van der Sijs H, Aarts J, Vulto A, Berg M: Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006, 13 (2): 138-47. 10.1197/jamia.M1809.CrossRefPubMedPubMedCentral
13.
Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH: Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc. 2007, 26-30.
14.
Khajouei R, Jaspers MW: The impact of CPOE medication systems' design aspects on usability, workflow and medication orders: a systematic review. Methods Inf Med. 2010, 49 (1): 3-19.PubMed
15.
16.
17.
18.
Beuscart R, McNair P, Brender J: Patient safety through intelligent procedures in medication: the PSIP project. Stud Health Technol Inform. 2009, 148: 6-13.PubMed
19.
Sittig DF, Krall MA, Dykstra RH, Russell A, Chin HL: A survey of factors affecting clinician acceptance of clinical decision support. BMC Med Inform Decis Mak. 2006, 6: 6-10.1186/1472-6947-6-6.CrossRefPubMedPubMedCentral
20.
Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS: Physicians' decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003, 163 (21): 2625-31. 10.1001/archinte.163.21.2625.CrossRefPubMed
21.
Strauss AL, Corbin JM: Basics of qualitative research: techniques and procedures for developing grounded theory. 1998, Thousand Oaks: Sage Publications, 2
22.
23.
van der Sijs H, Aarts J, van Gelder T, Berg M, Vulto A: Turning off frequently overridden drug alerts: limited opportunities for doing it safely. J Am Med Inform Assoc. 2008, 15 (4): 439-48. 10.1197/jamia.M2311.CrossRefPubMedPubMedCentral
24.
Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC: Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009, 16 (1): 40-6.CrossRefPubMedPubMedCentral
25.
26.
Riedmann D, Jung M, Hackl W, Stühlinger W, Ammenwerth E: Prioritization of alerts in CPOE systems using the clinical context - A mixed method study. Edited by: Schmücker P, Ellsässer KH, Hayna S. 2010, Mannheim, 362-3. 55th annual meeting of the GMDS
27.
Krall MA, Sittig DF: Clinician's assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements. Proc AMIA Symp. 2002, 400-4.
28.
Oppenheim MI, Mintz RJ, Boyer AG, Frayer WW: Design of a clinical alert system to facilitate development, testing, maintenance, and user-specific notification. Proc AMIA Symp. 2000, 630-4.
29.
Galanter WL, Didomenico RJ, Polikaitis A: A trial of automated decision support alerts for contraindicated medications using computerized physician order entry. J Am Med Inform Assoc. 2005, 12 (3): 269-74. 10.1197/jamia.M1727.CrossRefPubMedPubMedCentral
30.
Raebel MA, Charles J, Dugan J, Carroll NM, Korner EJ, Brand DW: Randomized trial to improve prescribing safety in ambulatory elderly patients. J Am Geriatr Soc. 2007, 55 (7): 977-85. 10.1111/j.1532-5415.2007.01202.x.CrossRefPubMed
31.
Grizzle AJ, Mahmood MH, Ko Y, Murphy JE, Armstrong EP, Skrepnek GH: Reasons provided by prescribers when overriding drug-drug interaction alerts. Am J Manag Care. 2007, 13 (10): 573-8.PubMed
32.
Abookire SA, Teich JM, Sandige H, Paterno MD, Martin MT, Kuperman GJ: Improving allergy alerting in a computerized physician order entry system. Proc AMIA Symp. 2000, 2-6.
33.
Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L: Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003, 10 (6): 523-30. 10.1197/jamia.M1370.CrossRefPubMedPubMedCentral
34.
Feldstein A, Simon SR, Schneider J, Krall M, Laferriere D, Smith DH: How to design computerized alerts to safe prescribing practices. Jt Comm J Qual Saf. 2004, 30 (11): 602-13.PubMed
35.
Isaac T, Weissman JS, Davis RB, Massagli M, Cyrulik A, Sands DZ: Overrides of medication alerts in ambulatory care. Arch Intern Med. 2009, 169 (3): 305-11. 10.1001/archinternmed.2008.551.CrossRefPubMed
36.
Lapane KL, Waring ME, Schneider KL, Dube C, Quilliam BJ: A mixed method study of the merits of e-prescribing drug alerts in primary care. J Gen Intern Med. 2008, 23 (4): 442-6. 10.1007/s11606-008-0505-4.CrossRefPubMedPubMedCentral
37.
Tamblyn R, Huang A, Taylor L, Kawasumi Y, Bartlett G, Grad R: A randomized trial of the effectiveness of on-demand versus computer-triggered drug decision support in primary care. J Am Med Inform Assoc. 2008, 15 (4): 430-8. 10.1197/jamia.M2606.CrossRefPubMedPubMedCentral
38.
Miyo K, Nittami YS, Kitagawa Y, Ohe K: Development of case-based medication alerting and recommender system: a new approach to prevention for medication error. Stud Health Technol Inform. 2007, 129 (Pt 2): 871-4.PubMed
39.
Kucher N, Puck M, Blaser J, Bucklar G, Eschmann E, Luscher TF: Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost. 2009, 7 (8): 1291-6. 10.1111/j.1538-7836.2009.03509.x.CrossRefPubMed
40.
Hsieh TC, Kuperman GJ, Jaggi T, Hojnowski-Diaz P, Fiskio J, Williams DH: Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system. J Am Med Inform Assoc. 2004, 11 (6): 482-91. 10.1197/jamia.M1556.CrossRefPubMedPubMedCentral
41.
Shah NR, Seger AC, Seger DL, Fiskio JM, Kuperman GJ, Blumenfeld B: Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006, 13 (1): 5-11. 10.1197/jamia.M1868.CrossRefPubMedPubMedCentral
42.
Judge J, Field TS, DeFlorio M, Laprino J, Auger J, Rochon P: Prescribers' responses to alerts during medication ordering in the long term care setting. J Am Med Inform Assoc. 2006, 13 (4): 385-90. 10.1197/jamia.M1945.CrossRefPubMedPubMedCentral
43.
Eslami S, de Keizer NF, Abu-Hanna A: The impact of computerized physician medication order entry in hospitalized patients--a systematic review. Int J Med Inform. 2008, 77 (6): 365-76. 10.1016/j.ijmedinf.2007.10.001.CrossRefPubMed
44.
Luna D, Otero V, Canosa D, Montenegro S, Otero P, de Quiros FG: Analysis and redesign of a knowledge database for a drug-drug interactions alert system. Stud Health Technol Inform. 2007, 129 (Pt 2): 885-9.PubMed
45.
Gross PA, Bates DW: A pragmatic approach to implementing best practices for clinical decision support systems in computerized provider order entry systems. J Am Med Inform Assoc. 2007, 14 (1): 25-8.CrossRefPubMedPubMedCentral
46.
Magnus D, Rodgers S, Avery AJ: GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther. 2002, 27 (5): 377-82. 10.1046/j.1365-2710.2002.00434.x.CrossRefPubMed
47.
Xie M, Johnson K: Applying human factors research to alert-fatigue in e-prescribing. AMIA Annu Symp Proc. 2007, 1161-
48.
van der Sijs H, Mulder A, van Gelder T, Aarts J, Berg M, Vulto A: Drug safety alert generation and overriding in a large Dutch university medical centre. Pharmacoepidemiol Drug Saf. 2009, 18 (10): 941-7. 10.1002/pds.1800.CrossRefPubMed
49.
Stutman HR, Fineman R, Meyer K, Jones D: Optimizing the acceptance of medication-based alerts by physicians during CPOE implementation in a community hospital environment. AMIA Annu Symp Proc. 2007, 701-5.
50.
Shah NR, Seger AC, Seger DL, Fiskio JM, Kuperman GJ, Blumenfeld B: Improving override rates for computerized prescribing alerts in ambulatory care. AMIA Annu Symp Proc. 2005, 1110-
51.
Krall MA, Sittig DF: Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting. Proc AMIA Symp. 2001, 334-8.
Metadata
Title
Development of a context model to prioritize drug safety alerts in CPOE systems
Authors
Daniel Riedmann
Martin Jung
Werner O Hackl
Wolf Stühlinger
Heleen van der Sijs
Elske Ammenwerth
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2011
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-11-35

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