Appropriateness of Alerts and Physicians’ Responses with a Medication-Related Clinical Decision Support System: Retrospective Observational Study

Background: Alert fatigue is unavoidable when many irrelevant alerts are generated in response to a small number of useful alerts. It is necessary to increase the effectiveness of the clinical decision support system (CDSS) by understanding physicians’ responses. Objective: This study aimed to understand the CDSS and physicians’ behavior by evaluating the clinical appropriateness of alerts and the corresponding physicians’ responses in a medication-related passive alert system. Methods: Data on medication-related orders, alerts, and patients’ electronic medical records were analyzed. The analyzed data were generated between August 2019 and June 2020 while the patient was in the emergency department. We evaluated the appropriateness of alerts and physicians’ responses for a subset of 382 alert cases and classified them. Results: Of the 382 alert cases, only 7.3% (n=28) of the alerts were clinically appropriate. Regarding the appropriateness of the physicians’ responses about the alerts, 92.4% (n=353) were deemed appropriate. In the classification of alerts, only 3.4% (n=13) of alerts were successfully triggered, and 2.1% (n=8) were inappropriate in both alert clinical relevance and physician’s response. In this study, the override rate was 92.9% (n=355). Conclusions: We evaluated the appropriateness of alerts and physicians’ responses through a detailed medical record review of the medication-related passive alert system. An excessive number of unnecessary alerts are generated, because the algorithm operates as a rule base without reflecting the individual condition of the patient. It is important to maximize the value of the CDSS by comprehending physicians’ responses.