Challenges to Reduce Alert Burden Using Current Decision Support Infrastructure in Two Commercial EHR Systems:...

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Electronic Health Records

Background:

• Excessive clinical decision support (CDS) alerts are often ignored by clinicians.
• A novel method to suppress false-positive alerts based on prior drug tolerance was developed.
• Integration into commercial electronic health record (EHR) systems encountered substantial barriers.

Purpose of the Study:

• To describe challenges integrating a custom CDS alert suppression method into two commercial EHR systems.
• To provide recommendations for future CDS research and design.
• To address the issue of clinically irrelevant alerts in EHR systems.

Main Methods:

• Investigated emergent CDS standards (e.g., CDS Hooks) for scalable alert augmentation.
• Attempted to customize commercial medication knowledge bases (MKBs) to reduce false-positive alerts.
• Explored manual inactivation of allergy documentation for patients with prior drug tolerance.

Main Results:

• The standards-based approach (CDS Hooks) was not suitable for suppressing existing vendor-supplied drug allergy alerts (DAAs).
• Commercial EHR systems lacked support for discrete clinical documentation changes needed to suppress MKB-imported alerts.
• Manually inactivating allergy documentation proved impractical due to the need for individual, ingredient-level rules.

Conclusions:

• Significant barriers preclude the implementation of a novel method to suppress clinically irrelevant CDS alerts in commercial EHRs.
• A more flexible CDS infrastructure is necessary for successful integration.
• Collaboration among diverse stakeholders is crucial for advancing CDS design and implementation.