Notifications Received by Primary Care Practitioners in Electronic Health Records: A Taxonomy and Time Analysis - 23/01/12
, Brian Reis, BE a, Dean F. Sittig, PhD d, Hardeep Singh, MD, MPH a, b
Requests for reprints should be addressed to Daniel R. Murphy, MD, MBA, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), HSR&D Center of Excellence (152), 2002 Holcombe Boulevard, Houston, TX 77030Abstract |
Background |
Asynchronous electronic health record (EHR)-based alerts used to notify practitioners via an inbox-like format rather than through synchronous computer “pop-up” messages are understudied. Our objective was to create an asynchronous alert taxonomy and measure the impact of different alert types on practitioner workload.
Methods |
We quantified and categorized asynchronous alerts according to the information they conveyed and conducted a time-motion analysis to assess practitioner workload. We reviewed alert information transmitted to all 47 primary care practitioners (PCPs) at a large, tertiary care Veterans Affairs facility over 4 evenly spaced 28-day periods. An interdisciplinary team used content analysis to categorize alerts according to their conveyed information. We then created an alert taxonomy and used it to calculate the mean number of alerts of each type PCPs received each day. We conducted a time-motion study of 26 PCPs while they processed their alerts. We used these data to estimate the uninterrupted time practitioners spend processing alerts each day.
Results |
We extracted 295,792 asynchronously generated alerts and created a taxonomy of 33 alert types categorized under 6 major categories: Test Results, Referrals, Note-Based Communication, Order Status, Patient Status Changes, and Incomplete Task Reminders. PCPs received a mean of 56.4 alerts/day containing new information. Based on 749 observed alert processing episodes, practitioners spent an estimated average of 49 minutes/day processing their alerts.
Conclusions |
PCPs receive a large number of EHR-based asynchronous alerts daily and spend significant time processing them. The utility of transmitting large quantities and varieties of alerts to PCPs warrants further investigation.
Le texte complet de cet article est disponible en PDF.Keywords : Asynchronous alerts, Classification, Electronic health records, Health information technology, Medical informatics, Primary care, Taxonomy, Time and motion studies
Plan
| Funding: This work was funded by the Veterans Affairs National Center for Patient Safety, Baylor College of Medicine Department of Family & Community Medicine Post Doctoral Fellowship program, a SHARP contract from the Office of the National Coordinator for Health Information Technology (ONC #10510592), and in part by the Houston VA HSR&D Center of Excellence (HFP90-020). These sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. |
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| Conflict of Interest: None. |
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| Authorship: All authors had full access to all of the data in the study, participated in the writing of the manuscript, and take responsibility for the integrity of the data and the accuracy of the data analysis. |
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| The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. |
Vol 125 - N° 2
P. 209.e1-209.e7 - février 2012 Retour au numéro
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