Optimising computerised decision support to transform medication safety and reduce prescriber burden

Electronic prescribing systems (ePS) with decision support are increasingly being adopted by hospitals and general practices as a means of improving efficiency and safety of prescribing. Computerised alerts embedded in ePS for doctors are triggered at the point of prescribing and are designed to warn prescribers about possible errors in their orders, such as Drug-Drug interactions (DDIs).Similarly, alerts embedded in pharmacy dispensing systems are triggered at the point of dispensing and are designed to warn pharmacists about possible errors in prescriptions, including DDIs.While DDI alerts have the potential to reduce errors, in reality they are frequently overridden. A range of factors which may potentially impact on the effectiveness of DDI alerts have been identified. This study will explore one such factor: alert interface design.

Background
The quality of the alert interface, i.e. how the alert appears to the system user, has been shown to influence prescriber acceptance of computerised alerts.There is also some evidence to suggest that applying human factors principles to alert design can improve usability and prescribing outcomes. In 2011, a human factors tool, the I-MeDeSA (Instrument for evaluating human factors principles in medication-related decision support alerts), was developed as an approach to evaluate the quality of DDI alert interfaces.This tool has been used to evaluate DDI alerts in 14 electronic health record systems (EHRs) in the United States but no assessments of Australian DDI alerts have been performed.

Aims
To compare the DDI alert interfaces in four hospital ePS, two General Practitioner (GP) software systems, and two pharmacist medication dispensing systems currently in use in Australia, in terms of their compliance with human factors principles of alert design; and to determine whether alerts which are more compliant with human factors principles are viewed more favourably by doctors and pharmacists.

Other members and collaborators:

David Lowenstein

Anmol Sandhu

Rosemary Burke

Eliza Kenny

Professor Richard Day