Design of a clinical alert system to facilitate development, testing, maintenance, and user-specific notification

Creation and maintenance of electronic clinical alerts within a hospital's electronic medical record (EMR) or database poses a number of challenges. Development can require significant programming effort. Final testing should ideally be performed in a real clinical environment without clinician notification, which may create technical challenges. After an alert is in production, modifications may become necessary in response clinician feedback, changes in clinical factors, or technical issues. Changes may be required in the knowledge base utilized by the alert or in the presentation of the alert condition to the clinicians. Occasionally, different users within the clinical environment may wish to have the same alert data presented differently. We have developed a strategy which allows development of multi-functional alerts and facilitates modification of alert function and/or presentation with minimal to no programming effort. Some elements of this scheme may be appropriate for incorporation into clinical alerting standards.