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Updated: Aug 30, 2025

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Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.

Vy T Ho1, Rachael C Aikens2, Geoffrey Tso3

  • 1Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.

Journal of the American Medical Informatics Association : JAMIA
|August 26, 2022
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Interruptive electronic alerts did not improve adherence to Choosing Wisely guidelines for reducing unnecessary lab tests. Further behavioral or educational interventions are needed to curb medical overuse.

Keywords:
Choosing Wiselyclinical decision supportinterruptive alertsrandomized controlled trial

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Area of Science:

  • Health Services Research
  • Clinical Informatics
  • Medical Decision Making

Background:

  • The American Board of Internal Medicine's Choosing Wisely initiative aims to reduce unnecessary laboratory testing.
  • Electronic health record (EHR) alerts are a potential tool to improve adherence to clinical guidelines.
  • The efficacy of interruptive alerts in reducing low-value care requires further investigation.

Purpose of the Study:

  • To evaluate the effectiveness of interruptive electronic alerts in enhancing clinician adherence to Choosing Wisely recommendations.
  • To assess the impact of alerts on reducing unnecessary laboratory testing across five clinical scenarios.

Main Methods:

  • Five simultaneous cluster randomized controlled trials were conducted in outpatient clinics.
  • Interruptive EHR alerts were implemented for prostate-specific antigen (PSA) testing, vitamin D testing, and other guidelines.
  • Outcomes included post-alert orders per 100 patients and the alert-to-order ratio.

Main Results:

  • No significant differences in post-alert orders per 100 patients were observed between alert and control groups.
  • The ratio of triggered alerts to orders did not significantly differ between groups.
  • A post hoc analysis showed reduced PSA alert triggering by providers exposed to PSA alerts.

Conclusions:

  • Interruptive point-of-care alerts did not demonstrate a significant impact on reducing unnecessary laboratory test orders.
  • Current alert systems may require complementary behavioral or educational strategies to effectively curb medical overuse.