Department of Manufacturing and Civil Engineering, Norwegian University of Science and Technology, Gjøvik, Norway.
Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway.
J Med Internet Res. 2020 Oct 28;22(10):e22013. doi: 10.2196/22013.
Clinical decision support (CDS) is a tool that helps clinicians in decision making by generating clinical alerts to supplement their previous knowledge and experience. However, CDS generates a high volume of irrelevant alerts, resulting in alert fatigue among clinicians. Alert fatigue is the mental state of alerts consuming too much time and mental energy, which often results in relevant alerts being overridden unjustifiably, along with clinically irrelevant ones. Consequently, clinicians become less responsive to important alerts, which opens the door to medication errors.
This study aims to explore how a blockchain-based solution can reduce alert fatigue through collaborative alert sharing in the health sector, thus improving overall health care quality for both patients and clinicians.
We have designed a 4-step approach to answer this research question. First, we identified five potential challenges based on the published literature through a scoping review. Second, a framework is designed to reduce alert fatigue by addressing the identified challenges with different digital components. Third, an evaluation is made by comparing MedAlert with other proposed solutions. Finally, the limitations and future work are also discussed.
Of the 341 academic papers collected, 8 were selected and analyzed. MedAlert securely distributes low-level (nonlife-threatening) clinical alerts to patients, enabling a collaborative clinical decision. Among the solutions in our framework, Hyperledger (private permissioned blockchain) and BankID (federated digital identity management) have been selected to overcome challenges such as data integrity, user identity, and privacy issues.
MedAlert can reduce alert fatigue by attracting the attention of patients and clinicians, instead of solely reducing the total number of alerts. MedAlert offers other advantages, such as ensuring a higher degree of patient privacy and faster transaction times compared with other frameworks. This framework may not be suitable for elderly patients who are not technology savvy or in-patients. Future work in validating this framework based on real health care scenarios is needed to provide the performance evaluations of MedAlert and thus gain support for the better development of this idea.
临床决策支持（CDS）是一种工具，通过生成临床警报来补充临床医生的先前知识和经验，帮助他们做出决策。然而，CDS 会生成大量不相关的警报，导致临床医生出现警报疲劳。警报疲劳是指警报消耗了太多时间和精力，导致临床医生不合理地忽略了相关警报，同时也忽略了不相关的警报。因此，临床医生对重要警报的反应能力下降，从而增加了用药错误的风险。
本研究旨在探讨基于区块链的解决方案如何通过在卫生部门共享协作警报来减少警报疲劳，从而提高患者和临床医生的整体医疗质量。
我们设计了一个 4 步方法来回答这个研究问题。首先，我们通过范围综述从已发表的文献中确定了五个潜在挑战。其次，设计了一个框架，通过使用不同的数字组件来解决这些挑战，从而减少警报疲劳。然后，通过与其他提出的解决方案进行比较，对 MedAlert 进行了评估。最后，还讨论了局限性和未来的工作。
在收集的 341 篇学术论文中，有 8 篇被选中并进行了分析。MedAlert 安全地将低级别（非危及生命）的临床警报分发给患者，从而实现协作式临床决策。在我们的框架中，选择了 Hyperledger（私有许可区块链）和 BankID（联合数字身份管理）来解决数据完整性、用户身份和隐私问题等挑战。
MedAlert 通过吸引患者和临床医生的注意力，而不仅仅是减少警报的总数，来减少警报疲劳。MedAlert 还具有其他优势，例如与其他框架相比，它可以确保更高程度的患者隐私和更快的交易时间。然而，该框架可能不适合不熟悉技术的老年患者或住院患者。未来需要在真实的医疗场景中验证该框架，以提供 MedAlert 的性能评估，并因此获得对该想法更好发展的支持。
