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User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease

Lipika Samal1,2, Sarah W Chen1, Stuart Lipsitz1,2,3

  • 1Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.

Applied Clinical Informatics
|March 17, 2025
PubMed

Insights

Physicians often override or defer clinical decision support (CDS) alerts for hypertension in chronic kidney disease, indicating hesitation to act immediately within the alert system.

Area of Science:

  • Clinical Informatics
  • Nephrology
  • Cardiology

Background:

  • Clinical decision support (CDS) alerts aim to improve care for patients with hypertension (HTN) and chronic kidney disease (CKD).
  • Understanding user interactions with these alerts is crucial for optimizing their effectiveness.

Purpose of the Study:

  • To analyze user actions and order completion rates within a CDS alert for HTN management in CKD patients.
  • To identify patterns of override, deferral, and order signing within the alert system.

Main Methods:

  • A pragmatic randomized controlled trial was conducted using a CDS alert with pre-checked orders for medication, lab tests (basic metabolic panel - BMP), and e-consults.
  • User actions, including order placement and signing, were examined for different alert firings.

Main Results:

  • High rates of alert override (59.6%) and deferral (14.6%) were observed.
  • CDS-recommended orders were signed approximately one-third of the time within the alert.
  • Order signing rates were higher for medication initiation compared to titration, with specific rates for ACE inhibitors and ARBs.

Conclusions:

  • Physicians demonstrate hesitancy to commit to immediate actions directly within the CDS alert.
  • Physician preferences and workflow nuances should guide future CDS alert design for better integration and adoption.

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