Office of the CMIO, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.
Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Appl Clin Inform. 2020 Jan;11(1):1-12. doi: 10.1055/s-0039-3402715. Epub 2020 Jan 1.
Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan.
The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts.
This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human-computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians.
The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship.
Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.
电子健康记录 (EHR) 警报疲劳虽然在全国范围内广受关注，但缺乏相应的全面缓解计划。
本文旨在为考虑创建管理 EHR 警报计划的临床信息专家和其他医疗保健领导者提供实用指南。
本文综合了来自美国四家医疗机构的几种更好的警报管理方法和建议，这四家医疗机构在美国佐治亚州亚特兰大举行的美国医学信息学协会 2019 年临床信息学会议上介绍了他们的经验和建议。这些医疗机构的领导人代表了学术、儿科、社区和专业护理领域。我们描述了治理和管理、结构概念和组件以及人机交互与警报，并根据我们的经验和文献综述对这些领域提出建议。本文重点介绍了影响床边临床医生的警报。
本文涉及与警报管理相关的一系列考虑因素，包括对警报背景文献的总结、警报治理、警报指标、启动警报管理计划、部署前评估警报的方法以及优化现有警报。本文包括来自两个代表机构的警报优化成功案例。此外，我们还回顾了当前评估警报能力的局限性，并确定了进一步开展学术研究的机会。
最终，警报管理计划必须努力实现改善患者护理的共同目标，同时减轻临床医生的警报负担。在这样做的过程中，组织有机会促进患者、临床医生和 EHR 本身的健康。
