Partners HealthCare Systems, Wellesley, MA 02481, USA.
J Am Med Inform Assoc. 2013 May 1;20(3):489-93. doi: 10.1136/amiajnl-2012-001089. Epub 2012 Sep 25.
Alert fatigue represents a common problem associated with the use of clinical decision support systems in electronic health records (EHR). This problem is particularly profound with drug-drug interaction (DDI) alerts for which studies have reported override rates of approximately 90%. The objective of this study is to report consensus-based recommendations of an expert panel on DDI that can be safely made non-interruptive to the provider's workflow, in EHR, in an attempt to reduce alert fatigue.
We utilized an expert panel process to rate the interactions. Panelists had expertise in medicine, pharmacy, pharmacology and clinical informatics, and represented both academic institutions and vendors of medication knowledge bases and EHR. In addition, representatives from the US Food and Drug Administration and the American Society of Health-System Pharmacy contributed to the discussions.
Recommendations and considerations of the panel resulted in the creation of a list of 33 class-based low-priority DDI that do not warrant being interruptive alerts in EHR. In one institution, these accounted for 36% of the interactions displayed.
Development and customization of the content of medication knowledge bases that drive DDI alerting represents a resource-intensive task. Creation of a standardized list of low-priority DDI may help reduce alert fatigue across EHR.
Future efforts might include the development of a consortium to maintain this list over time. Such a list could also be used in conjunction with financial incentives tied to its adoption in EHR.
提醒疲劳是与电子病历（EHR）中临床决策支持系统的使用相关的一个常见问题。对于药物-药物相互作用（DDI）警报，这个问题尤其严重，研究报告的忽略率约为 90%。本研究的目的是报告一个专家小组关于 DDI 的基于共识的建议，这些建议可以在 EHR 中安全地非中断地提供给提供者的工作流程，以试图减少提醒疲劳。
我们利用专家小组的流程来对相互作用进行评分。小组成员在医学、药学、药理学和临床信息学方面具有专业知识，代表了医疗机构和药物知识库以及 EHR 的供应商。此外，来自美国食品和药物管理局和美国卫生系统药剂师协会的代表也参与了讨论。
小组的建议和考虑导致创建了一个 33 种基于类别的低优先级 DDI 列表，这些 DDI 在 EHR 中不需要中断提醒。在一个机构中，这些占显示的相互作用的 36%。
药物知识库内容的开发和定制是一项资源密集型任务，它驱动着 DDI 警报的产生。创建一个标准化的低优先级 DDI 列表可能有助于减轻整个 EHR 中的提醒疲劳。
未来的努力可能包括建立一个联盟来维护这个列表。该列表还可以与与在 EHR 中采用相关的经济激励措施一起使用。
