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Emphasis on Support in Decision Support

Greg Freeman for HealthLeaders Media, May 14, 2012

Out of every 100 orders for medication, about 10 have an alert that changes the doctor's behavior by canceling the drug, changing the dosage, or adding a monitoring test, Smith says. Last year, Adventist Health System clinicians ordered 6.6 million medications by CPOE, and there were about 650,000 alerts that changed behavior.

Those are encouraging numbers, Smith says, but Adventist Health System also tries hard to avoid "alert fatigue" in which so many alerts fire during CPOE that clinicians ignore them. The provider monitors the override rate for each alert. In March 2011, the rate climbed from the typical two overrides per 100 alerts to almost nine overrides per 100. That was a sign of alert fatigue, Smith says, so the committees went back and revised some alerts to make them more effective.

Striking a balance between too many nuisance alerts and not enough alerts to keep the patient safe can be a challenge, Smith says. In many scenarios, the best strategy is to incorporate alerts that give the physician the ability to override the decision support and use his or her own judgment. That is not prudent in some extreme cases in which conflicting orders or drug interactions are always wrong, but relying on the physician's expertise is key to making decision support work, Smith says.

"We always try to remember that we're supporting the physician and providing information so he or she can make the best decision," Smith says. "We found out early on in the process that doctors don't want a computer barking orders at them and telling them how to take care of their patients. They want information and polite reminders, but they don't want a computer taking over their job."

Greg Freeman is a contributing writer for HealthLeaders Media.


This article appears in the May 2012 issue of HealthLeaders magazine.


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