Clinical Decision Support and Alerting Mechanisms

Abstract

More than 55 % of US hospitals have electronic health records (EHRs); frequently these contain computerized decision support (CDS) in the form of alerts. Alerts are a common form of CDS often implemented for medication ordering and decision support to improve patient care. EHRs implement rules supplied by third-party vendors to help guide the dosing process include weight-based dosing. Since many of these rules are conservative, they result in noisy alerting and are therefore overridden by users. Alert fatigue is commonly studied and reported by providers. EHR implementers customize these rules to reduce noise. Adverse drug events are a common occurrence, prevalent in both adult and pediatric populations. However, there are few automated ways to identify adverse drug events. Weight-based dosing guidance for medication orders has limited functionality if the patient’s body weight is entered incorrectly. Despite safeguards intended to prevent weight data-entry errors, erroneous weights exist in patients’ charts. These pose a safety threat to patients, especially inpatients, whose medication doses may be calculated from the last recorded weight. In this chapter we will give an overview of pediatric clinical decision support in EHRs, the different modes and forms of CDS, as well as diving into several related and specific areas of CDS – medication dosing alerts and the detection of weight data entry errors. We will review these common sources of error and frustration in the EHR, how errors can be identified, and changes implemented to mitigate the errors.