TY - JOUR
T1 - Prescribers' interactions with medication alerts at the point of prescribing
T2 - A multi-method, in situ investigation of the human-computer interaction
AU - Russ, Alissa L.
AU - Zillich, Alan J.
AU - McManus, M. Sue
AU - Doebbeling, Bradley N.
AU - Saleem, Jason J.
N1 - Funding Information:
We would like to express our gratitude to the study participants. It has been an honor to observe their work. We also wish to thank the many local and national VA informatics specialists who helped answer our questions about the alert system. Thanks to Richard Frankel, PhD, for input on qualitative methods. Ms. Diana Lunsford assisted with Fig. 2 graphics. This research was supported by the VA HSR&D Center of Excellence on Implementing Evidence-Based Practice , Center grant # HFP 04-148 . Dr. Russ was funded in part by a VA HSR&D Associated Health Postdoctoral Fellowship . Drs. Zillich and Saleem were each supported by VA HSR&D Research Career Development Awards . Preliminary study findings were presented at the Human Factors and Ergonomics Society Annual Meeting [41,58] and American Medical Informatics Association (AMIA) Symposium [59] . Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2012/4
Y1 - 2012/4
N2 - Purpose: Few studies have examined prescribers' interactions with medication alerts at the point of prescribing. We conducted an in situ, human factors investigation of outpatient prescribing to uncover factors that influence the prescriber-alert interaction and identify strategies to improve alert design. Methods: Field observations and interviews were conducted with outpatient prescribers at a major Veterans Affairs Medical Center. Physicians, clinical pharmacists, and nurse practitioners were recruited across five primary care clinics and eight specialty clinics. Prescribers were observed in situ as they ordered medications for patients and resolved alerts. Researchers collected 351 pages of typed notes across 102 hours of observations and interviews. An interdisciplinary team identified emergent themes via inductive qualitative analysis. Results: Altogether, 320 alerts were observed among 30 prescribers and their interactions with 146 patients. Qualitative analysis uncovered 44 emergent themes and 9 overarching factors, which were organized into a framework that describes the prescriber-alert interaction. Prescribers' ability to act on alerts was impeded by the alert interface, which did not adequately support all prescriber types. Conclusions: This empiric study produced a novel framework for understanding the prescriber-alert interaction. Results revealed key components of the alert interface that influence prescribers and indicate a need for more universal design. Actionable design recommendations are presented and may be used to enhance alert design and patient safety.
AB - Purpose: Few studies have examined prescribers' interactions with medication alerts at the point of prescribing. We conducted an in situ, human factors investigation of outpatient prescribing to uncover factors that influence the prescriber-alert interaction and identify strategies to improve alert design. Methods: Field observations and interviews were conducted with outpatient prescribers at a major Veterans Affairs Medical Center. Physicians, clinical pharmacists, and nurse practitioners were recruited across five primary care clinics and eight specialty clinics. Prescribers were observed in situ as they ordered medications for patients and resolved alerts. Researchers collected 351 pages of typed notes across 102 hours of observations and interviews. An interdisciplinary team identified emergent themes via inductive qualitative analysis. Results: Altogether, 320 alerts were observed among 30 prescribers and their interactions with 146 patients. Qualitative analysis uncovered 44 emergent themes and 9 overarching factors, which were organized into a framework that describes the prescriber-alert interaction. Prescribers' ability to act on alerts was impeded by the alert interface, which did not adequately support all prescriber types. Conclusions: This empiric study produced a novel framework for understanding the prescriber-alert interaction. Results revealed key components of the alert interface that influence prescribers and indicate a need for more universal design. Actionable design recommendations are presented and may be used to enhance alert design and patient safety.
KW - CPOE
KW - Electronic prescribing
KW - Human factors engineering
KW - Medication alert systems
KW - Medication errors
UR - http://www.scopus.com/inward/record.url?scp=84858153681&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84858153681&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2012.01.002
DO - 10.1016/j.ijmedinf.2012.01.002
M3 - Article
C2 - 22296761
AN - SCOPUS:84858153681
SN - 1386-5056
VL - 81
SP - 232
EP - 243
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 4
ER -