Personalized audio warning alerts in medicine

Modern Electronic Health Record (EHR) systems are now integral to healthcare. Having evolved from hospital billing and laboratory systems in the 80's, EHR systems have grown considerably as we learn to represent more and more aspects of patient encounter, diagnosis and treatment digitally. EHR user interfaces, however, lag considerably behind their consumer-electronics counterparts in usability, most notably with respect to customizability. This limitation is especially evident in the implementation of audible alerts that are coupled to sensors or timing devices in intensive-care settings. The most current standard, (ISO/IEC 60601-1-8) has been designed for alerts that are intended to signal situations of varying priorities: however, it is not universally implemented, and has been criticized for the difficulty that healthcare providers have in discriminating between individual alarms, and for the failure to incorporate prior research with respect to "sense of urgency" as it applies to alarm efficacy. In the present work, however, we consider that there are more effective means to allow a user to identify an alarm correctly than "sense of urgency" response.

This thesis focuses on the problem of correct identification of alerts: what happens when a human subject is allowed to create or designate (i.e., personalize) one's own alerts? Given the ubiquity, low costs and commoditization of consumer-electronics devices, we believe that it is just a matter of time before such devices become the norm in critical care and replace existing, special-purpose devices for information delivery at the point of patient care.

We built a tool, PASA (Personalized Alert Study Application), that would allow us to capture and edit sounds and orchestrate studies that would contrast any two types of sounds. PASA facilitated a study where study participant's responses to "personalized" sounds were contrasted with sounds that meet the ISO/IEC 60601-1-8:2012 standard.

We performed two sub-studies that contrasted responses to two banks of 6-alerts and 10-alerts. The 6-alert study was repeated with the same subjects after two weeks without training to measure recall. We observed that accuracy, reaction time, and retention were significantly improved with the personalized sounds. For example, the median errors for the 6-alert baseline study were 4 for personalized vs. 27 for standard alerts. For the 6-alert repeat study it was 7 vs. 43. The median for the 10-alert study was 1 for personalized vs. 55 for standard alerts. Accuracy for recognition, while remaining constant for personalized alerts, degraded considerably for standardized alerts as the number of alerts increased from 6 to 10.

We conclude that personalization of alerts may improve information delivery and reduce cognitive overload on the health care provider. This potential positive effect at the point of patient care merits further studies in a clinical or simulated clinical setting.