Decision support systems can alert physicians to the existence of drug interactions.The Hospital Italiano de Buenos Aires,Argentina,has an in-house electronic health record with computerized physician order entry and clinical decision support.It includes a drug-drug interaction alert system,initially developed under traditional engineering techniques.As we detected a high alert override rate,we rebuilt the knowledge database and redesigned the alert interface with User-Centered Design techniques.A laboratory crossover study using clinical vignettes showed that new alerts were more usable than traditional ones.This paper aimed to validate these results through a controlled and randomized experimental study with two branches(old vs.new design)in a real setting.We analyzed,quantitatively,every fired alert between April 2015 and September 2016.Finally,we performed user surveys and qualitative interviews to inquire about their satisfaction and perceptions.In real scenarios,user-centered design alerts were more usable,being more effective and satisfactory,but less efficient than traditional alerts.Safe omission,as a new concept,emerged from our stratified analyses and interviews.
Drug Interactions Expert Systems Software Design
Daniel R Luna Daniel A Rizzato Lede Luciana Rubin Carlos M Otero Juan M Ortiz Mónica G García Romina P Rapisarda Marcelo R Risk Fernán González Bernaldo de Quirós
Department of Health Informatics,Hospital Italiano de Buenos Aires,Argentina;Instituto Tecnológico d Department of Health Informatics,Hospital Italiano de Buenos Aires,Argentina Department of Health Informatics,Hospital Italiano de Buenos Aires,Argentina;Instituto Tecnológico d Medical Vice-Direction of Strategic Planning,Hospital Italiano de Buenos Aires,Argentina