Comparison of Medication Alerts from Two Commercial Applications in the USA
Open Access
- 22 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Drug Safety
- Vol. 44 (6), 661-668
- https://doi.org/10.1007/s40264-021-01048-0
Abstract
Introduction Medication organizations across the USA have adopted electronic health records, and one of the most anticipated benefits of these was improved medication safety, but alert fatigue has been a major issue. Objective We compared the appropriateness of medication-related clinical decision support alerts triggered by two commercial applications: EPIC and Seegnal’s platform. Methods This was a retrospective comparison of two commercial applications. We provided Seegnal with deidentified inpatient, outpatient, and inpatient genetic electronic medical record (EMR)-extracted datasets for 657, 2731, and 413 patients, respectively. Seegnal then provided the alerts that would have triggered, which we compared with those triggered by EPIC in clinical care. A random sample of the alerts triggered were reviewed for appropriateness, and the positive predictive value (PPV) and negative predictive value (NPV) were calculated. We also reviewed all the inpatient and outpatient charts for patients within our cohort who were receiving ten or more concomitant medications with alerts we found to be appropriate to assess whether any adverse events had occurred and whether Seegnal’s platform could have prevented them. Results Results from EPIC and the Seegnal platform were compared based on alert load, PPV, NPV, and potential adverse events. Overall, compared with EPIC, the Seegnal platform triggered fewer alerts in the inpatient (1697 vs. 27,540), outpatient (2341 vs. 35,134), and inpatient genetic (1493 vs. 20,975) cohorts. The Seegnal platform had higher specificity in the inpatient (99 vs. 0.3%; p < 0.0001), outpatient (99 vs. 0.3%; p < 0.0001), and inpatient genetic (97.9 vs. 1.2%; p < 0.0001) groups and higher sensitivity in the inpatient (100 vs. 68.8%; p < 0.0001) and outpatient (88.6 vs.78.3%; p < 0.0001) groups but not in the inpatient genetic cohort (81 vs. 78.5%; p = 0.11). We identified 16 adverse events that occurred in the inpatient setting, 11 (69%) of which potentially could have been prevented with the Seegnal platform. Conclusions Overall, the Seegnal platform triggered 94% fewer alerts than EPIC in the inpatient setting and 93% fewer in the outpatient setting, with much higher sensitivity and specificity. This application could substantially reduce alert fatigue and improve medication safety at the same time.Keywords
Funding Information
- Seegnal
This publication has 23 references indexed in Scilit:
- On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshopBMC Medical Informatics and Decision Making, 2013
- Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record SystemJournal of the American Medical Informatics Association, 2008
- The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic ReviewJournal of General Internal Medicine, 2008
- Just What the Doctor Ordered. Review of the Evidence of the Impact of Computerized Physician Order Entry System on Medication ErrorsHealth Services Research, 2007
- Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A ReviewJournal of the American Medical Informatics Association, 2007
- National Surveillance of Emergency Department Visits for Outpatient Adverse Drug EventsJAMA, 2006
- Concealed Renal Insufficiency and Adverse Drug Reactions in Elderly Hospitalized PatientsArchives of Internal Medicine, 2005
- Characteristics and Consequences of Drug Allergy Alert Overrides in a Computerized Physician Order Entry SystemJournal of the American Medical Informatics Association, 2004
- Physicians' Decisions to Override Computerized Drug Alerts in Primary CareArchives of Internal Medicine, 2003
- Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication SafetyArchives of Internal Medicine, 2003