Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals

Author:

Van Dort Bethany A1ORCID,Zheng Wu Yi1,Sundar Vivek2,Baysari Melissa T1

Affiliation:

1. Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

2. Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

Abstract

Abstract Objective To identify and summarize the current internal governance processes adopted by hospitals, as reported in the literature, for selecting, optimizing, and evaluating clinical decision support (CDS) alerts in order to identify effective approaches. Materials and methods Databases (Medline, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore Digital Library, CADTH, and WorldCat) were searched to identify relevant papers published from January 2010 to April 2020. All paper types published in English that reported governance processes for selecting and/or optimizing CDS alerts in hospitals were included. Results Eight papers were included in the review. Seven papers focused specifically on medication-related CDS alerts. All papers described the use of a multidisciplinary committee to optimize alerts. Other strategies included the use of clinician feedback, alert data, literature and drug references, and a visual dashboard. Six of the 8 papers reported evaluations of their CDS alert modifications following the adoption of optimization strategies, and of these, 5 reported a reduction in alert rate. Conclusions A multidisciplinary committee, often in combination with other approaches, was the most frequent strategy reported by hospitals to optimize their CDS alerts. Due to the limited number of published processes, variation in system changes, and evaluation results, we were unable to compare the effectiveness of different strategies, although employing multiple strategies appears to be an effective approach for reducing CDS alert numbers. We recommend hospitals report on descriptions and evaluations of governance processes to enable identification of effective strategies for optimization of CDS alerts in hospitals.

Funder

The University of Sydney

Publisher

Oxford University Press (OUP)

Subject

Health Informatics

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