Language
English
Publication Date
4-1-2025
Journal
Journal of the American Medical Informatics Association
DOI
10.1093/jamia/ocaf013
PMID
39903167
PMCID
PMC12005624
PubMedCentral® Posted Date
2-4-2025
PubMedCentral® Full Text Version
Post-print
Abstract
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.
Keywords
Cross-Sectional Studies, Humans, Electronic Health Records, Medical Order Entry Systems, Academic Medical Centers, Pediatrics, Child, United States, electronic health records, decision support systems, benchmarking
Published Open-Access
yes
Recommended Citation
Kandaswamy, Swaminathan; Yarahuan, Julia K W; Dobler, Elizabeth A; et al., "Alert Design in the Real World: A Cross-Sectional Analysis of Interruptive Alerting at 9 Academic Pediatric Health Systems" (2025). Faculty, Staff and Students Publications. 7607.
https://digitalcommons.library.tmc.edu/baylor_docs/7607