TY - JOUR
T1 - Avoiding alert fatigue in pulmonary embolism decision support
T2 - A new method to examine 'trigger rates'
AU - Press, Anne
AU - Khan, Sundas
AU - McCullagh, Lauren
AU - Schachter, Andy
AU - Pardo, Salvatore
AU - Kohn, Nina
AU - McGinn, Thomas
N1 - Publisher Copyright:
© 2016 Published by the BMJ Publishing Group Limited.
PY - 2016/12
Y1 - 2016/12
N2 - A clinical decision support system (CDSS) is integrated into the electronic health record (EHR) and allows physicians to easily use a clinical decision support (CDS) tool. However, often CDSSs are integrated into the EHR with poor adoption rates. One reason for this is secondary to ' trigger fatigue'. Therefore, we developed a new and innovative usability process named ' sensitivity and specificity trigger analysis' (SSTA) as part of our larger project around a pulmonary embolism decision support tool. SSTA will enable programmers to examine optimal trigger rates prior to the integration of a CDS tool into the EHR, by using a formal method of analysis. We performed a retrospective chart review. The outcome of interest was physician ordering of a CT angiography (CTA). Phrases that signify common symptoms associated with pulmonary embolism were assessed as possible triggers for the CDSS tool. We then analysed each trigger's ability to predict physician ordering of a CTA. We found that the most sensitive way to trigger the Pulmonary Embolism CDS tool while still maintaining a high specificity was by combining 1 or more pertinent symptoms with 1 or more elements of the Wells criteria. This study explored a unique methodology, SSTA, used to limit inaccurate triggering of a CDS tool prior to integration into the EHR. This methodology can be applied to other studies aiming to decrease triggering rates and increase adoption rates of previously validated CDSS tools.
AB - A clinical decision support system (CDSS) is integrated into the electronic health record (EHR) and allows physicians to easily use a clinical decision support (CDS) tool. However, often CDSSs are integrated into the EHR with poor adoption rates. One reason for this is secondary to ' trigger fatigue'. Therefore, we developed a new and innovative usability process named ' sensitivity and specificity trigger analysis' (SSTA) as part of our larger project around a pulmonary embolism decision support tool. SSTA will enable programmers to examine optimal trigger rates prior to the integration of a CDS tool into the EHR, by using a formal method of analysis. We performed a retrospective chart review. The outcome of interest was physician ordering of a CT angiography (CTA). Phrases that signify common symptoms associated with pulmonary embolism were assessed as possible triggers for the CDSS tool. We then analysed each trigger's ability to predict physician ordering of a CTA. We found that the most sensitive way to trigger the Pulmonary Embolism CDS tool while still maintaining a high specificity was by combining 1 or more pertinent symptoms with 1 or more elements of the Wells criteria. This study explored a unique methodology, SSTA, used to limit inaccurate triggering of a CDS tool prior to integration into the EHR. This methodology can be applied to other studies aiming to decrease triggering rates and increase adoption rates of previously validated CDSS tools.
UR - http://www.scopus.com/inward/record.url?scp=84988693949&partnerID=8YFLogxK
U2 - 10.1136/ebmed-2016-110440
DO - 10.1136/ebmed-2016-110440
M3 - Article
C2 - 27664174
AN - SCOPUS:84988693949
SN - 1356-5524
VL - 21
SP - 203
EP - 207
JO - Evidence-Based Medicine
JF - Evidence-Based Medicine
IS - 6
ER -