Right Idea, Wrong Time: Focusing on Alert Timing for Effective Decision Support

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Workflow Optimization

Background:

• Clinical decision support (CDS) interventions enhance guideline adherence and reduce errors, but poor integration into clinical workflows can cause alert fatigue and burnout.
• The
• Five Rights
• framework highlights the importance of proper timing and relevance for CDS effectiveness.

Purpose of the Study:

• To evaluate and redesign three interruptive CDS alerts within a large safety-net health system.
• To improve alignment of CDS alerts with clinician workflows, minimize interruptions, and enhance compliance with care guidelines.

Main Methods:

• Analysis of three interruptive CDS alerts using Epic's SlicerDicer tool, examining frequency, triggers, and user responses.
• Modification of alerts to optimize timing and relevance within clinical workflows, including retiming, lockout periods, and visit-type restrictions.

Main Results:

• Retiming an HIV screening alert reduced firings by 87% and increased screening orders.
• An administrative alert's frequency decreased by 86% with a lockout period, maintaining compliance.
• A pediatric head circumference alert restricted to in-person visits eliminated telehealth interruptions.

Conclusions:

• Aligning CDS with clinical workflows using the
• Five Rights
• framework reduces interruptions and improves outcomes.
• Iterative review, user feedback, and proactive redesign are crucial for effective CDS, especially with evolving care models like telehealth.