Abstract
Background and objectives: The aim of this study is to describe the temporal change in alert override with a minimally interruptive clinical decision support (CDS) on a Next-Generation electronic medical record (EMR) and analyze factors associated with the change. Materials and Methods: The minimally interruptive CDS used in this study was implemented in the hospital in 2016, which was a part of the new next-generation EMR, Data Analytics and Research Window for Integrated kNowledge (DARWIN), which does not generate modals, ‘pop-ups’ but show messages as in-line information. The prescription (medication order) and alerts data from July 2016 to December 2017 were extracted. Piece-wise regression analysis and linear regression analysis was performed to determine the temporal change and factors associated with it. Results: Overall, 2,706,395 alerts and 993 doctors were included in the study. Among doctors, 37.2% were faculty (professors), 17.2% were fellows, and 45.6% trainees (interns and residents). The overall override rate was 61.9%. There was a significant change in an increasing trend at month 12 (p < 0.001). We found doctors’ positions and specialties, along with the number of alerts and medication variability, were significantly associated with the change. Conclusions: In this study, we found a significant temporal change of alert override. We also found factors associated with the change, which had statistical significance.
Highlights
Clinical decision support (CDS) plays a critical role in everyday clinical practice
A clinical decision support (CDS) to electronic medical record (EMR) is like an application to a smartphone, which is essentially intertwined with users and the work process
We found factors that were related to an increase in alert overrides
Summary
Clinical decision support (CDS) plays a critical role in everyday clinical practice. Combined with advanced electronic medical records (EMRs), CDS is identified as a key for quality medicine, improving the safety and effectiveness of healthcare [1,2,3]. The use of CDS is associated with better adherence to clinical guidelines, a reduction in morbidity, and a reduction in medical errors [4,5,6,7]. These merits of CDS are influenced by various factors because the system is often integrated into complicated clinical settings [8,9]. The aim of this study is to describe the temporal change in alert override with a minimally interruptive clinical decision support (CDS) on a Next-Generation electronic medical record (EMR) and analyze factors associated with the change.
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