University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB UK.
BMC Med Inform Decis Mak. 2013 Oct 1;13:111. doi: 10.1186/1472-6947-13-111.
Clinical decision support (CDS) for electronic prescribing systems (computerized physician order entry) should help prescribers in the safe and rational use of medicines. However, the best ways to alert users to unsafe or irrational prescribing are uncertain. Specifically, CDS systems may generate too many alerts, producing unwelcome distractions for prescribers, or too few alerts running the risk of overlooking possible harms. Obtaining the right balance of alerting to adequately improve patient safety should be a priority.
A workshop funded through the European Regional Development Fund was convened by the University Hospitals Birmingham NHS Foundation Trust to assess current knowledge on alerts in CDS and to reach a consensus on a future research agenda on this topic. Leading European researchers in CDS and alerts in electronic prescribing systems were invited to the workshop.
We identified important knowledge gaps and suggest research priorities including (1) the need to determine the optimal sensitivity and specificity of alerts; (2) whether adaptation to the environment or characteristics of the user may improve alerts; and (3) whether modifying the timing and number of alerts will lead to improvements. We have also discussed the challenges and benefits of using naturalistic or experimental studies in the evaluation of alerts and suggested appropriate outcome measures.
We have identified critical problems in CDS, which should help to guide priorities in research to evaluate alerts. It is hoped that this will spark the next generation of novel research from which practical steps can be taken to implement changes to CDS systems that will ultimately reduce alert fatigue and improve the design of future systems.
电子处方系统（计算机化医嘱录入）的临床决策支持（CDS）应该有助于医生安全合理地使用药物。然而，提醒用户注意不安全或不合理处方的最佳方法尚不确定。具体来说，CDS 系统可能会生成太多的警报，给医生带来不必要的干扰，或者生成太少的警报，从而有可能忽略可能的危害。获得适当的警报平衡以充分提高患者安全性应成为优先事项。
英国伯明翰大学医院 NHS 基金会信托基金通过欧洲区域发展基金资助举办了一次研讨会，以评估当前关于 CDS 警报的知识，并就这一主题的未来研究议程达成共识。邀请了欧洲 CDS 和电子处方系统警报方面的主要研究人员参加研讨会。
我们确定了重要的知识差距，并提出了研究重点，包括（1）确定警报的最佳灵敏度和特异性的必要性；（2）是否适应环境或用户的特征可以改善警报；以及（3）是否修改警报的时间和数量将导致改进。我们还讨论了在评估警报时使用自然主义或实验研究的挑战和益处，并提出了适当的结果衡量标准。
我们已经确定了 CDS 中的关键问题，这应该有助于指导评估警报的研究重点。希望这将激发下一代新的研究，从中可以采取切实步骤来改变 CDS 系统，从而最终减少警报疲劳并改善未来系统的设计。
