警报设计在现实世界:中断警报在9个学术儿科卫生系统的横断面分析。

IF 4.6 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS
Swaminathan Kandaswamy, Julia K W Yarahuan, Elizabeth A Dobler, Matthew J Molloy, Lindsey A Knake, Sean M Hernandez, Anne A Fallon, Lauren M Hess, Allison B McCoy, Regine M Fortunov, Eric S Kirkendall, Naveen Muthu, Evan W Orenstein, Adam C Dziorny, Juan D Chaparro
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引用次数: 0

摘要

目的:评估推荐设计元素在儿科医疗机构实施电子健康记录(EHR)中断警报中的流行程度。材料和方法:我们进行了一项3期混合方法的横断面研究。第一阶段涉及开发用于警报内容分类的代码本。第2阶段确定了参与站点最频繁的中断警报。第三阶段使用密码本对警报进行分类。报告了码本的内部信度(IRR)和警报设计内容的描述性统计。结果:我们根据设计元素对警报内容进行分类,如警报外观的基本原理、忽略它的危害、指示与信息内容、管理目的,以及它是否符合医学研究所(IOM)的医疗质量领域之一。除了识别警报之外的指令内容(IRR 0.58)和警报是否仅用于管理目的(IRR 0.36)之外,大多数设计元素的IRR都达到了0.7以上。IRR在除股权外的所有IOM领域都很差。各机构在独特警报的数量和设计上差异很大。78%的警报说明了它们的目的,超过一半是指令,13%是信息。只有2%-20%的警报解释了不作为的后果。讨论:本研究提出了关于警报功能的最佳平衡和警报表示的理想特征的重要问题。结论:我们的研究首次提供了对儿科护理环境中电子病历警报设计元素的多中心分析,揭示了内容和设计的实质性变化。这些发现强调了未来的研究需要通过实验探索电子病历警报设计的最佳实践,以提高效率和有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Alert design in the real world: a cross-sectional analysis of interruptive alerting at 9 academic pediatric health systems.

Objective: To assess the prevalence of recommended design elements in implemented electronic health record (EHR) interruptive alerts across pediatric care settings.

Materials and methods: We conducted a 3-phase mixed-methods cross-sectional study. Phase 1 involved developing a codebook for alert content classification. Phase 2 identified the most frequently interruptive alerts at participating sites. Phase 3 applied the codebook to classify alerts. Inter-rater reliability (IRR) for the codebook and descriptive statistics for alert design contents were reported.

Results: We classified alert content on design elements such as the rationale for the alert's appearance, the hazard of ignoring it, directive versus informational content, administrative purpose, and whether it aligned with one of the Institute of Medicine's (IOM) domains of healthcare quality. Most design elements achieved an IRR above 0.7, with the exceptions for identifying directive content outside of an alert (IRR 0.58) and whether an alert was for administrative purposes only (IRR 0.36). IRR was poor for all IOM domains except equity. Institutions varied widely in the number of unique alerts and their designs. 78% of alerts stated their purpose, over half were directive, and 13% were informational. Only 2%-20% of alerts explained the consequences of inaction.

Discussion: This study raises important questions about the optimal balance of alert functions and desirable features of alert representation.

Conclusion: Our study provides the first multi-center analysis of EHR alert design elements in pediatric care settings, revealing substantial variation in content and design. These findings underline the need for future research to experimentally explore EHR alert design best practices to improve efficiency and effectiveness.

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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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