Alerts & Report Design:
Important Lessons Learnt
Melissa Yong – Pharmacist & Test Manager
Peninsula Health
SERVICE • INTEG...
Alert Fatigue
Introduction
Need
Alerts
Design
Alerts
Too
Many
Alerts
Alert
Fatigue
Need
Safe
System
SERVICE • INTEGRITY • COMPASSION • R...
Why does it happen?
• Novelty factor
• “The computer should tell me”
• Design without analysis
• Specialty-centric vs big ...
Context Awareness
Source: Riedmann et al. BMC Medical Informatics and Decision Making
2011, 11:35
SERVICE • INTEGRITY • CO...
Factors to Consider
• Scope, triggers & parameters:
eg. patient, drug, location, user
• Target audience
• When it fires
• ...
Alert Fatigue
• Alerts
– VTE Risk Assessment
– Allergy Recording
– Height and Weight
– Same Name
– Interaction alerts
– Hi...
Principles of Design
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Design Tips
SIMPLE & QUICK
• Design it for the lowest denominator
• 1-2-3 OK
INTUITIVE
• Make the most of your system’s ca...
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Design Tips
USEFUL
• Integrate it into workflow
• Relevant (context aware)
BANG
• Succinct wording
• Implement graphic/vis...
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Visual Design: Focus
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Example: Warfarin Alert
Warfarin Ordering at Peninsula
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Question
How do you stop unintended duplicate
orders?
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Duplicate Warfarin Alerts
Active inpatient warfarin orders
with administration task?
Future warfarin orders for the
same d...
Duplicate Warfarin Alerts
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Already administered today?
Duplicate Warfarin Alert
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
WARFARIN ORDER ALREADY EXISTS
Do you wish...
Other Tools
• Warfarin activity report
– History of doses/withholds in last 10 days
– Shows corresponding INR results
– Cr...
Warfarin Activity Report
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Using Reports
• Identify mishaps
– Discharge Summary Audits
• Prioritise Clinician workload
– Warfarin
– Restricted Meds R...
Reports for Auditing
• Allergy KPI report
• Unendorsed Results KPI
• Discharge Prescription Extract
• In the pipes:
– Medi...
Conclusion
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Not always alerts!
• Complete analysis pre-design
• T...
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Melissa Yong, Release Management and Test Lead, Peninsula Health Network - Important Lessons Learnt in Using Alerts and Reporting

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Melissa Yong delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in: Health & Medicine
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Melissa Yong, Release Management and Test Lead, Peninsula Health Network - Important Lessons Learnt in Using Alerts and Reporting

  1. 1. Alerts & Report Design: Important Lessons Learnt Melissa Yong – Pharmacist & Test Manager Peninsula Health SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  2. 2. Alert Fatigue
  3. 3. Introduction Need Alerts Design Alerts Too Many Alerts Alert Fatigue Need Safe System SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  4. 4. Why does it happen? • Novelty factor • “The computer should tell me” • Design without analysis • Specialty-centric vs big picture • Unaware of system capabilities • Downstream impact
  5. 5. Context Awareness Source: Riedmann et al. BMC Medical Informatics and Decision Making 2011, 11:35 SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  6. 6. Factors to Consider • Scope, triggers & parameters: eg. patient, drug, location, user • Target audience • When it fires • End-user’s required response • Wording SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  7. 7. Alert Fatigue • Alerts – VTE Risk Assessment – Allergy Recording – Height and Weight – Same Name – Interaction alerts – High Dose Insulin – Duplicate Warfarin – Renal Alert – Antimicrobial Alert – PBS approval Open chart Add to ScratchPad Sign rule SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  8. 8. Principles of Design SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  9. 9. Design Tips SIMPLE & QUICK • Design it for the lowest denominator • 1-2-3 OK INTUITIVE • Make the most of your system’s capabilities and limitations • Test it with the right people • Clinical relevance, not technical detail SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  10. 10. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  11. 11. Design Tips USEFUL • Integrate it into workflow • Relevant (context aware) BANG • Succinct wording • Implement graphic/visual design principles SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  12. 12. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  13. 13. Visual Design: Focus SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  14. 14. Example: Warfarin Alert Warfarin Ordering at Peninsula SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  15. 15. Question How do you stop unintended duplicate orders? SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  16. 16. Duplicate Warfarin Alerts Active inpatient warfarin orders with administration task? Future warfarin orders for the same date? Duplicate Dose Check automatically cancelled SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  17. 17. Duplicate Warfarin Alerts SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Already administered today?
  18. 18. Duplicate Warfarin Alert SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE WARFARIN ORDER ALREADY EXISTS Do you wish to continue?
  19. 19. Other Tools • Warfarin activity report – History of doses/withholds in last 10 days – Shows corresponding INR results – Crosses encounters – Filtered by ward or medical unit • Patient-level Warfarin Report • Discharge Warfarin Report SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  20. 20. Warfarin Activity Report SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  21. 21. Using Reports • Identify mishaps – Discharge Summary Audits • Prioritise Clinician workload – Warfarin – Restricted Meds Report* – Medication History & Reconciliation* • 2nd Tier Downtime back-up SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  22. 22. Reports for Auditing • Allergy KPI report • Unendorsed Results KPI • Discharge Prescription Extract • In the pipes: – Medication History & Reconciliation – Missed Dose Audit SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  23. 23. Conclusion SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE • Not always alerts! • Complete analysis pre-design • Testing is part of the design process • KISS
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