Developing a Better Clinical Alert System in EHRs


Don’t miss User-View’s poster presentation at the 2015 International Symposium on Human Factors and Ergonomics in Health Care: Improving the Outcomes; https://www.hfes.org//Web/HFESMeetings/2015HealthCareSymposium.html!

Jennifer Mauney, Caleb Furlough, and Janey Barnes  will be presenting.  Here is the summary:

Currently, many alert systems designed for EHRs are in a state which is negatively affect providers’ ability to prescribe appropriately and thus, is also affecting patient safety. There is a wealth of information in the human factors literature on the design and use of alerts but that information is either not known or has not been implemented in the design of EHRs. This paper will bring that literature to light, and demonstrate how to implement the recommendations to develop not only a better system for handling alerts in EHRs, but better CPOE (Computerized Provider Order Entry) as well. Serious usability issues with medication-based alerts displayed on EHRs were found after reviewing the data from the Meaningful Use 2 (MU2) Usability reports linked to the ONC CHPL website. The types of alert system issues found within the MU2 Usability reports and across various EHR vendors as well as human factors research that specifies how to deal with these issues will be described in this paper. In addition, recommendations for the design of medication-based alerts will be presented.

References

Belden, J., Patel, J., Lowrance, N., Plaisant, C., Koopman, R., Moore, J., Johnson, T. R., & Sonin, J. (2014) EHR Usability Style Guide. Retrieved from http://InspiredEHRs.com.

Belden, J. and Barnes, J. (2010) ARRA and EMR usability: What providers need to know.  Paper presented at the annual meeting of the Healthcare Information and Systems Society, Atlanta, GA.

Belden, J., Patel, J., Lowrance, N., Plaisant, C., Koopman, R., Moore, J., Johnson, T. R., & Sonin, J. (2014) Inspired EHRs: Designing for Clinicians. Retrieved from http://InspiredEHRs.com.

Bettman, J.R., Payne, J.W., and Staelin, R. (1986). Cognitive considerations in designing effective labels for presenting risk information. Journal of Public Policy and Marketing, 5, 1-28.

Furlough, C., Barnes, J., Mauney, J., Belk, A., Blanchard, L., Brooks, T., Brown, M., & Glasscock, N. (2014, 17-19 March). Observed usage errors during meaningful use stage 2 safety-enhanced design summative testing. HFES 2014 International Symposium on Human Factors and Ergonomics in Health Care Proceedings, Chicago, Illinois.

hguptamd. (2014, March 19). eprescribe [Video file]. Retrieved from https://www.youtube.com/watch?v=y16r7wtZ7S0.

Kesselheim, A. S., Cresswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011). Clinical decision support systems could be modified to reduce ‘alert fatigue’while still minimizing the risk of litigation. Health Affairs30(12), 2310-2317.

Microsoft Health (2010) [image], retrieved from http://www.mscui.net/.

Miller, G. (1956). The magic number seven, plus or minus two: Some limits on our capacity for processing information. Psychology Review, 63, 81-97.

Osborne, P. D., Barsam, H. F., and Burgy., D. C. (1981). Human factors considerations for implementation of a “green board” concept in an existing “red/green” power plant control room. In R. C. Sugarman (Ed.), Proceedings of the 25th annual meeting of the Human Factors Society.  Santa Monica, CA: Human Factors.

Phansalkar, S., Edworthy, J., Hellier, E., Seger, D. L., Schedlbauer, A., Avery, A. J., & Bates, D. W. (2010). A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. Journal of the American Medical Informatics Association17(5), 493-501.

Pritchett, A. R., Vandor, B., & Edwards, K. (2002). Testing and implementing cockpit alerting systems. Reliability Engineering & System Safety75(2), 193-206.

Rasmussen, J., and Lind, M. (1981).  Coping with Complexity.  In H. G. Stassen (Ed.), First European Annual Conference on Human Decision Making and Manual Control. New York: Plenum Press.

Sanders, M. S. and McCormick, E. J. (1993). Human factors in engineering and design.  New York: McGraw-Hill, Inc.

Schneider, S. C. (1987). Information overload: Causes and consequences. Human Systems Management7(2), 143-153.

Sweller, J. (1988). Cognitive load during problem solving: Effects on learning.Cognitive science12(2), 257-285.

Wickens, C. D. (1984). Engineering psychology and human performance.  Columbus, Ohio: Merrill.

Wogalter, Michael S. & Kenneth R. Laughery (1996). WARNING! Sign and label effectiveness. Current Directions in Psychological Science, 5 (2), 33-37.

Wogalter, M., Desaulniers, D., and Godfrey, s. (1985). Perceived effectiveness of environmental warnings.  Proceedings of the Human Factors Society 29th annual meeting.  Santa Monica, CA: Human Factors Society, 664-668.

Young, S.L., (1991). Increasing the noticeability warnings: effects of pictoiral, color, signal icon and border. Proceedings of the Human Factors Society 35th Annual Meeting, pp.580-584. Santa Monica, CA.