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UID:HFESHCS_2024 International Symposium on Human Factors and Ergonomics i
 n Health Care_sess128_POST218@linklings.com
SUMMARY:DH3 - Challenges and Solutions of Developing Usable EHR Alerts
DESCRIPTION:Poster Presentation\n\nRichard J. Simonson (Children's Mercy; 
 University of Missouri, Kansas City SOM); Eryn Godwin (Children's Mercy); 
 Carmen Van Ommen (Embry-Riddle Aeronautical University); Kate Vanlandingha
 m (Children’s Mercy Kansas City); and Sarah Fouquet (Children’s Mercy Kans
 as City; University of Missouri, Kansas City SOM)\n\nThe development and i
 mplementation of patient care plans is a process encompassing significant 
 levels of information flow, whose processing and synthesis can generate up
  to 50 million gigabytes of data each year (World Economic Forum, 2019). T
 he clinicians involved in this process are subsequently tasked with decomp
 osing this multi-faceted and multi-sourced information into clear and acti
 onable care decisions. Subsequently, significant efforts have focused on i
 dentifying gaps in care and developing tools and technologies to assist cl
 inicians in this work. These efforts have led to findings that show substa
 ntial safety and organizational health risks due to incomplete or missed i
 nformation during care. For example, prior literature indicates that clini
 cians must navigate around the fact that upwards of 60%-70% of all prescri
 bed medications in hospital settings have moderate to severe interaction r
 isks (Rodrigues et al., 2017). Similarly, information-gathering processes 
 to form clinical decisions suffer from disproportionate rates of unnecessa
 ry blood draws and lab tests (Vrijsen et al., 2020; Lewandrowski, 2011). F
 ortunately, many interventions have been implemented to assist clinicians 
 in organizing, interpreting, and acting on information. One intervention, 
 and the focus of this panel submission, is the Electronic Health Record (E
 HR) and Clinical Decision Support (CDS) alert systems. \n\nEHR alerts repr
 esent informational and interactive popups within a medical database inter
 face to inform the user about a patient's health or warn about a possible 
 future health state. These alerts have a variety of functionality and intr
 actability that range from informational (e.g., no required interaction), 
 forced interaction (e.g., the user must select some option), or forced sto
 p states (e.g., preventing an action from taking place within the system).
  They are applicable in a variety of settings, including during patient or
 ders (e.g., medications and labs), information review (i.e., alerting that
  a patient has not received a medication), and also during non-direct pati
 ent care (i.e., alerts during supply management). Unfortunately, significa
 nt barriers to successfully implementing these alerts diminish their effec
 tiveness (Jung et al., 2020). These include but are not limited to, 1) the
  intricate knowledge needed to interact with and implement alert system pa
 rameters, 2) knowledge and skill in developing in HTML, CSS, and Javascrip
 t, 3) lack of usability and design guidance for alert displays, and 4) the
  challenge of building alerts that attune to both the trigger scenario and
  the mental model of the clinician at the time of activating.\n\nThese bar
 riers have led to an overwhelmingly lackluster response from the providers
  in their interaction and adoption of alerts into their workflow. Many rep
 orts show significant rates of user dissatisfaction in their interactions 
 with EHR alerts, which may be reflected by the suggestion that up to 90% o
 f pharmacists and physicians choose to overwrite these alerts (Brodowy & N
 guyen, 2016). Alternatively, the clinicians may acknowledge alerts when tr
 iggering, but the required action may not be appropriate or available refl
 ecting the challenges of implementing alerts in an appropriate and usable 
 manner (Iii et al., 2020). In response, research initiatives have called f
 or Human Factors and Human-Centered Design (HCD) approaches to combat thes
 e challenges and inform the development of practical and applicable alerts
 . Unfortunately, little focus has been applied to developing practical and
  implementable guidance for the analysts who create and apply alerts withi
 n hospitals. \n\nThis poster will present and discuss the challenges and a
 pplicable solutions for developing, designing, and implementing EHR alerts
  into practice within a hospital setting. Multiple perspectives will be re
 presented via a frontline view from our Hospital’s Clinical Decision Suppo
 rt and alert development committee member and Director of Provider Informa
 tics, an operational and implementation approach from embedded human facto
 rs and user experience practitioners, and an academic and research approac
 h via user experience researchers.\n\nReferences\n\nBrodowy, B., & Nguyen,
  D. (2016). Optimization of clinical decision support through minimization
  of excessive drug allergy alerts. American Journal of Health-System Pharm
 acy, 73(8), 526–528. https://doi.org/10.2146/ajhp150252\nIii, J. D. M., Ma
 llozzi, C. P., Perkins, R. M., Shelov, E., & Schreiber, R. (2020). Reducin
 g Alert Burden in Electronic Health Records: State of the Art Recommendati
 ons from Four Health Systems. Applied Clinical Informatics, 11(1), 1–12. h
 ttps://doi.org/10.1055/s-0039-3402715\nJung, S. Y., Hwang, H., Lee, K., Le
 e, H.-Y., Kim, E., Kim, M., & Cho, I. Y. (2020). Barriers and Facilitators
  to Implementation of Medication Decision Support Systems in Electronic Me
 dical Records: Mixed Methods Approach Based on Structural Equation Modelin
 g and Qualitative Analysis. JMIR Medical Informatics, 8(7), e18758. https:
 //doi.org/10.2196/18758\nLewandrowski, K. (2011). POC testing in the emerg
 ency department: Strategies to improve clinical and operational outcomes. 
 Acutecaretesting. https://acutecaretesting.org/en/articles/poc-testing-in-
 the-emergency-department-strategies-to-improve-clinical-and-operational-ou
 tcomes\nRodrigues, A. T., Stahlschmidt, R., Granja, S., Pilger, D., Falcão
 , A. L. E., & Mazzola, P. G. (2017). Prevalence of potential drug-drug int
 eractions in the intensive care unit of a Brazilian teaching hospital. Bra
 zilian Journal of Pharmaceutical Sciences, 53, e16109. https://doi.org/10.
 1590/s2175-97902017000116109\nWorld Economic Forum. (2019, December 5). Fo
 ur ways data is improving healthcare. World Economic Forum. https://www.we
 forum.org/agenda/2019/12/four-ways-data-is-improving-healthcare/\n\nTrack:
  Digital Health, Simulation and Education, Hospital Environments, Medical 
 and Drug Delivery Devices, Patient Safety Research and Initiatives
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