Journal article
Right Idea, Wrong Time: Focusing on Alert Timing for Effective Decision Support
Applied clinical informatics, Vol.16(4), pp.1200-1207
08/01/2025
DOI: 10.1055/a-2605-4510
PMID: 40360000
Abstract
Background
Effective clinical decision support (CDS) interventions improve adherence to care guidelines, reduce prescribing errors, and, in some settings, decrease patient mortality. However, misalignment with the “Five Rights” framework, particularly regarding CDS timing in clinical workflows, can lead to implementation failures, alert fatigue, and physician burnout.
Objectives
This case series aimed to evaluate and redesign three interruptive CDS alerts at a large safety net health system to better align with clinician workflows, reduce interruptions, and improve compliance with care guidelines.
Methods
We analyzed three interruptive alerts using data from Epic's SlicerDicer tool, focusing on alert frequency, contributors to alert triggering, and user responses before and after intervention. Alerts were modified to improve their timing and relevance within the workflow.
Results
Modifications included retiming a human immunodeficiency virus screening alert to trigger during laboratory test orders, reducing alert firings by 87% while increasing monthly screening orders from 3,561 to 4,547 (p < 0.001). An administrative alert's firing frequency decreased by 86% through the introduction of a 4-hour lockout period, maintaining compliance rates. Finally, restricting a pediatric head circumference discrepancy alert to in-person visits only eliminated interruptions during telehealth encounters, addressing a major source of clinician frustration.
Conclusion
Aligning CDS tools with clinical workflows through adherence to the “Five Rights” framework reduces interruptions and improves outcomes. Iterative review, user feedback, and proactive redesign are essential to ensure CDS effectiveness, particularly as health care evolves to include novel care delivery models like telehealth.
Details
- Title: Subtitle
- Right Idea, Wrong Time: Focusing on Alert Timing for Effective Decision Support
- Creators
- Averi E. Wilson - The University of Texas Southwestern Medical CenterAndrew P. Bain - The University of Texas Southwestern Medical CenterJanet Webb - The University of Texas Southwestern Medical CenterChristoph U. Lehmann - The University of Texas Southwestern Medical CenterBrett Moran - Parkland Health & Hospital SystemNainesh Shah - The University of Texas Southwestern Medical CenterEllen O'Connell - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Applied clinical informatics, Vol.16(4), pp.1200-1207
- DOI
- 10.1055/a-2605-4510
- PMID
- 40360000
- NLM abbreviation
- Appl Clin Inform
- ISSN
- 1869-0327
- eISSN
- 1869-0327
- Number of pages
- 8
- Language
- English
- Date published
- 08/01/2025
- Academic Unit
- Stead Family Department of Pediatrics; Internal Medicine
- Record Identifier
- 9985123699602771
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