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Improving Patient Safety by Means of Health Information Technology

English title Improving Patient Safety by Means of Health Information Technology
Applicant Beeler Patrick
Number 148619
Funding scheme Early Postdoc.Mobility
Research institution Department of Medicine Brigham and Womens Hospital
Institution of higher education Institution abroad - IACH
Main discipline Internal Medicine
Start/End 01.02.2014 - 31.07.2015
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All Disciplines (2)

Discipline
Internal Medicine
Information Technology

Keywords (11)

patient safety; health information technology; guideline adherence; overriding; venous thromboembolism; medical informatics research; drug-drug interactions; alert fatigue; clinical decision support; computerized physician order entry; non-interruptive reminders

Lay Summary (German)

Lead
In vielen Bereichen des Alltags trägt die Informatik zur Personensicherheit bei. Auch in der Medizin spielt sie eine zunehmend wichtige Rolle. Studien haben gezeigt, dass medizininformatische Hinweise das Personal bei ihrer klinischen Arbeit unterstützen, die Behandlungsqualität verbessern und die Kosten senken können.
Lay summary

Inhalt und Ziel des Forschungsprojekts

Es wurden mehrere Fragestellungen untersucht, insbesondere rund um das Phänomen "alert fatigue": Es wurde analysiert, weshalb das Spitalpersonal medizininformatische Hinweise häufig ignoriert. Dabei wurde festgestellt, dass ein hoher Anteil dieser Hinweise zu Recht ignoriert wird, weil z.B. der Hinweis in einer bestimmten Situation irrelevant ist. Um die Relevanz eines medizininformatischen Hinweises und die richtige Reaktion des Fachpersonals beurteilen zu können, wurden Kriterien entwickelt, welche in mehreren Projekten eingesetzt werde konnten, u.a. bei medizininformatischen Warnungen vor Medikamentenallergien.

Forscher haben untersucht, weshalb in manchen geographischen Regionen z.B. ein bestimmter chirurgischer Eingriff häufig durchgeführt wird, in anderen Regionen selten. Diese sog. Variabilität wurde noch nie bei medizininformatischen Hinweisen untersucht. Interessanterweise reagierten die Fachpersonen insbesondere dann variabel, wenn die medizininformatischen Empfehlungen ignoriert wurden, obwohl sie in dieser Situation angebracht waren und hätten befolgt werden sollen.

Eine andere medizininformatische Fragestellung war, inwiefern Medikamente auf Diagnosen rückschliessen lassen. Es zeigte sich, dass nicht nur Medikamente mit bestimmten Diagnosen assoziiert sind, sondern dass die Verabreichungsart und Dosis diese Assoziationen noch verstärken können.

Wissenschaftlicher und gesellschaftlicher Kontext

Mit dem Aufkommen der elektronischen Krankenakte in Schweizer Spitälern können unter wissenschaftlich kontrollierten Bedingungen medizininformatische Hinweise eingeführt werden, die auf klinisch relevante Probleme hinweisen. Es muss künftig darauf geachtet werden, dass diese Hinweise fokussierter, d.h. beim richtigen Patienten, zur richtigen Zeit und in der richtigen Situation eingeblendet werden, um das bestmögliche Potential zu entfalten. Von dieser Unterstützung profitieren das Fachpersonal und somit auch die Patienten.

 

Direct link to Lay Summary Last update: 11.09.2015

Responsible applicant and co-applicants

Publications

Publication
Medication-related clinical decision support alert overrides in inpatients.
Nanji Karen C, Seger Diane L, Slight Sarah P, Amato Mary G, Beeler Patrick E, Her Qoua L, Dalleur Olivia, Eguale Tewodros, Wong Adrian, Silvers Elizabeth R, Swerdloff Michael, Hussain Salman T, Maniam Nivethietha, Fiskio Julie M, Dykes Patricia C, Bates David W (2017), Medication-related clinical decision support alert overrides in inpatients., in Journal of the American Medical Informatics Association : JAMIA.
Evaluation of medication-related clinical decision support alert overrides in the intensive care unit.
Wong Adrian, Amato Mary G, Seger Diane L, Slight Sarah P, Beeler Patrick E, Dykes Patricia C, Fiskio Julie M, Silvers Elizabeth R, Orav E John, Eguale Tewodros, Bates David W (2017), Evaluation of medication-related clinical decision support alert overrides in the intensive care unit., in Journal of critical care, 39, 156-161.
A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.
Slight Sarah Patricia*, Beeler Patrick E* (*joint first authors), Seger Diane L, Amato Mary G, Her Qoua L, Swerdloff Michael, Dalleur Olivia, Nanji Karen C, Cho InSook, Maniam Nivethietha, Eguale Tewodros, Fiskio Julie M, Dykes Patricia C, Bates David W (2017), A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement., in BMJ quality & safety, 26(3), 217-225.
Automated identification of an aspirin-exacerbated respiratory disease cohort.
Cahill Katherine N, Johns Christina B, Cui Jing, Wickner Paige, Bates David W, Laidlaw Tanya M, Beeler Patrick E (2017), Automated identification of an aspirin-exacerbated respiratory disease cohort., in The Journal of allergy and clinical immunology, 139(3), 819.
30-Day Potentially Avoidable Readmissions Due to Adverse Drug Events.
Dalleur Olivia, Beeler Patrick E, Schnipper Jeffrey L, Donzé Jacques (2017), 30-Day Potentially Avoidable Readmissions Due to Adverse Drug Events., in Journal of patient safety.
Automated identification of an aspirin-exacerbated respiratory disease cohort
Cahill KN, Johns CB, Cui J, Wickner P, Bates DW, Laidlaw TM, Beeler PE (2017), Automated identification of an aspirin-exacerbated respiratory disease cohort, in The Journal of Allergy and Clinical Immunology, 819.
The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.
Her Qoua L, Amato Mary G, Seger Diane L, Beeler Patrick E, Slight Sarah P, Dalleur Olivia, Dykes Patricia C, Gilmore James F, Fanikos John, Fiskio Julie M, Bates David W (2016), The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting., in Journal of the American Medical Informatics Association : JAMIA, 23(5), 924-33.
Impact of Hyponatremia Correction on the Risk for 30-Day Readmission and Death in Patients with Congestive Heart Failure.
Donzé Jacques D*, Beeler Patrick E* (*joint first authors), Bates David W (2016), Impact of Hyponatremia Correction on the Risk for 30-Day Readmission and Death in Patients with Congestive Heart Failure., in The American journal of medicine, 129(8), 836-42.
Provider variation in responses to warnings: do the same providers run stop signs repeatedly?
Beeler Patrick E, Orav E John, Seger Diane L, Dykes Patricia C, Bates David W (2016), Provider variation in responses to warnings: do the same providers run stop signs repeatedly?, in Journal of the American Medical Informatics Association : JAMIA, 23(e1), 93-8.
Development of an algorithm to assess appropriateness of override non-formulary medication alerts in a computer provider order entry system
Her QL, Seger DL, Amato MG, Beeler PE, Dalleur O, Slight SP, Dykes PC, Bates DW (2016), Development of an algorithm to assess appropriateness of override non-formulary medication alerts in a computer provider order entry system, in Am J Health Syst Pharm, e34.
Development of an algorithm to assess appropriateness of overriding alerts for nonformulary medications in a computerized prescriber-order-entry system.
Her Qoua L, Seger Diane L, Amato Mary G, Beeler Patrick E, Dalleur Olivia, Slight Sarah P, Dykes Patricia C, Bates David W (2016), Development of an algorithm to assess appropriateness of overriding alerts for nonformulary medications in a computerized prescriber-order-entry system., in American journal of health-system pharmacy : AJHP : official journal of the American Society of Heal, 73(1), 34-45.
Clinical decision support systems.
Beeler Patrick Emanuel, Bates David Westfall, Hug Balthasar Luzius (2014), Clinical decision support systems., in Swiss medical weekly, 144, 14073-14073.
30-day potentially avoidable readmissions due to adverse drug events
Dalleur O, Beeler PE, Schnipper JL, Donzé J, 30-day potentially avoidable readmissions due to adverse drug events, in J Patient Saf.
A Cross-Sectional, Observational Study of High Override Rates of Drug Allergy Alerts in Inpatient and Outpatient Settings and Opportunities for Improvement
Slight Sarah P.*, Beeler Patrick E.* (*co-first authors), Seger Diane L., Amato Mary G., Her Qoua L., Swerdloff Michael, Dalleur Olivia, Nanji Karen C., Cho Insook, Maniam Nivethietha, Eguale Tewodros, Fiskio Julie M., Dykes Patricia C., Bates David W., A Cross-Sectional, Observational Study of High Override Rates of Drug Allergy Alerts in Inpatient and Outpatient Settings and Opportunities for Improvement, in BMJ Quality & Safety.
The Frequency of Inappropriate Non-Formulary Medication Alert Overrides in the Inpatient Setting
Her QL, Amato MG, Seger DL, Beeler PE, Slight SP, Dalleur O, Dykes PC, Gilmore JF, Fanikos J, Fiskio JM, Bates DW, The Frequency of Inappropriate Non-Formulary Medication Alert Overrides in the Inpatient Setting, in J Am Med Inform Assoc..

Collaboration

Group / person Country
Types of collaboration
K.N. Cahill, MD; Div. of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
David W. Bates, MD, MSc; Division of General Internal Medicine, Brigham and Women's Hospital, Boston United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
swiss ehealth summit 2015 Talk given at a conference Predicting Diagnoses with Drug Orders, Routes and Doses 14.09.2015 Bern, Switzerland Beeler Patrick;
83. SGIM-Jahresversammlung Poster Impact of hyponatremia correction on the risk of 30-day readmission and death in patients with congestive heart failure 20.05.2015 Basel, Switzerland Beeler Patrick;
SGIM 38th Annual Meeting Poster Impact of hyponatremia correction on the risk of 30-day readmission and death in patients with congestive heart failure 22.04.2015 Toronto, Canada Beeler Patrick;
SGIM 38th Annual Meeting Poster 30-day potentially avoidable readmissions due to adverse drug events in medical patients 22.04.2015 Toronto, Canada Beeler Patrick;
SGIM 38th Annual Meeting Poster An evaluation of drug-allergy interaction alert overrides in inpatients 22.04.2015 Toronto, Canada Beeler Patrick;
SGIM 38th Annual Meeting Poster An evaluation of computerized medication alert override behavior in inpatient and ambulatory care 22.04.2015 Toronto, Canada Beeler Patrick;


Awards

Title Year
Distinguished Poster Award for “An Evaluation of ‘Definite’ Anaphylaxis Drug Allergy Alert Overrides in Both Inpatient and Outpatient Settings” (co-author), AMIA 2016 Annual Symposium, Chicago 2016
SGMI Best Conference Contribution Award for “Automated identification of hospital-acquired venous thromboembolism”, Swiss eHealth Summit, Bern 2016
Partners in Excellence Team Award “Physician Level Variation in Medication Overrides of Computerized Decision Support” Brigham and Women’s Hospital, Boston, 2015 Jan 12 2015
SGMI Paper Award (best conference contribution/presentation) "Predicting Diagnoses with Drug Orders, Routes and Doses" swiss ehealth summit, Bern, 2015 Sep 15 2015

Abstract

Health information technology has the potential to increase quality of care and reduce costs. Several studies have shown that computerized physician order entry in combination with clinical decision support (CDS) is able to substantially improve patient safety. However, the psychological phenomenon called ‘alert fatigue’ limits the impact of CDS. Peterson and Bates describe alert fatigue as the mental state that is the result of a high number of alerts consuming time and mental energy, therefore increasing the risk of overriding alerts and missing potentially important notifications. In order to maximize the impact of CDS some authors recommend to reduce the number of false positive alerts, to include clear information within the alert, and to use non-interruptive reminders whenever possible, instead of disrupting the workflow.At the Brigham and Women’s Hospital (BWH), Boston MA, research has been conducted to reduce the number of interruptive drug-drug interaction alerts to a minimum. These efforts resulted in a set of 15 high-priority drug-drug interactions for which warnings should be generated in all electronic health records. At the University Hospital Zurich (USZ), an on-demand drug-drug interaction checker has been implemented in order to avoid alert fatigue. Further, an algorithm reminding physicians to consider ordering prophylaxis against venous thromboembolism has been investigated and incrementally improved during almost 7 years. These non-interruptive reminders increased the rate of appropriate thromboprophylaxis and had a sustained impact. A recent study showed that the new version of the algorithm specifically recognized unnecessary reminders and reduced the reminder burden by 62%, thus minimizing the risk of alert fatigue.
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