title: A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.
abstract: The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. sphansalkar@partners.org
authors.forename: Shobha
authors.initials: S
authors.lastname: Phansalkar
authors.forename: Judy
authors.initials: J
authors.lastname: Edworthy
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hellier
authors.forename: Diane L
authors.initials: DL
authors.lastname: Seger
authors.forename: Angela
authors.initials: A
authors.lastname: Schedlbauer
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Avery
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D006804:Ergonomics / Q000379:methods*; D006751:Hospital Information Systems / Q000458:organization & administration*; D006801:Humans; D050316:Medical Order Entry Systems
references.citation: Qual Saf Health Care. 2004 Jun;13(3):186-90
references.pmid: 15175488
references.citation: Qual Saf Health Care. 2006 Apr;15(2):81-4
references.pmid: 16585104
references.citation: Ergonomics. 1995 Nov;38(11):2188-206
references.pmid: 7498184
references.citation: J Am Med Inform Assoc. 2007 Jan-Feb;14(1):29-40
references.pmid: 17068355
references.citation: Hum Factors. 2004 Spring;46(1):11-31
references.pmid: 15151153
references.citation: Ergonomics. 1995 Nov;38(11):2207-20
references.pmid: 7498185
references.citation: J Am Med Inform Assoc. 2002 Nov-Dec;9(6 Suppl):S75-7
references.pmid: 12386188
references.citation: Risk Anal. 1994 Oct;14(5):789-98
references.pmid: 7800863
references.citation: JAMA. 1998 Oct 21;280(15):1311-6
references.pmid: 9794308
references.citation: Arch Intern Med. 2003 Nov 24;163(21):2625-31
references.pmid: 14638563
references.citation: Stud Health Technol Inform. 2004;107(Pt 2):1063-7
references.pmid: 15360975
references.citation: Am J Health Syst Pharm. 2001 Aug 1;58(15):1428-31
references.pmid: 11494789
references.citation: Proc Annu Symp Comput Appl Med Care. 1994;:996
references.pmid: 7950101
references.citation: J Biomed Inform. 2004 Jun;37(3):193-204
references.pmid: 15196483
references.citation: J Biomed Inform. 2004 Feb;37(1):30-42
references.pmid: 15016384
references.citation: Int J Med Inform. 2008 Jun;77(6):365-76
references.pmid: 18023611
references.citation: Comput Biomed Res. 1989 Dec;22(6):575-87
references.pmid: 2686930
references.citation: J Am Med Inform Assoc. 2004 Nov-Dec;11(6):482-91
references.pmid: 15298998
references.citation: J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
references.pmid: 10428004
references.citation: BMJ. 2004 May 15;328(7449):1171-2
references.pmid: 15142922
references.citation: J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12
references.pmid: 14633936
references.citation: J Appl Psychol. 1967 Oct;51(5):417-25
references.pmid: 6074392
references.citation: Ergonomics. 1995 Nov;38(11):2300-12
references.pmid: 7498189
references.citation: Ergonomics. 1970 Jan;13(1):101-17
references.pmid: 5416864
references.citation: Proc AMIA Symp. 2000;:2-6
references.pmid: 11080034
references.citation: J Biomed Inform. 2001 Feb;34(1):52-66
references.pmid: 11376543
references.citation: J Am Med Inform Assoc. 2006 Jan-Feb;13(1):5-11
references.pmid: 16221941
references.citation: Ergonomics. 2000 Sep;43(9):1283-300
references.pmid: 11014752
references.citation: Proc AMIA Annu Fall Symp. 1996;:704-8
references.pmid: 8947756
references.citation: Am J Infect Control. 2005 Oct;33(8):439-43
references.pmid: 16216656
references.citation: Risk Anal. 1994 Oct;14(5):779-88
references.pmid: 7800862
references.citation: Health Serv Res. 2008 Feb;43(1 Pt 1):32-53
references.pmid: 18211517
references.citation: J Am Med Inform Assoc. 2009 Jan-Feb;16(1):40-6
references.pmid: 18952941
references.citation: BMJ. 2000 Mar 18;320(7237):750-3
references.pmid: 10720357
references.citation: J Am Med Inform Assoc. 2006 Mar-Apr;13(2):138-47
references.pmid: 16357358
references.citation: Stud Health Technol Inform. 2004;107(Pt 2):1101-5
references.pmid: 15360983
references.citation: Int J Med Inform. 2005 Aug;74(7-8):615-22
references.pmid: 16043086
references.citation: Risk Anal. 1994 Oct;14(5):815-28
references.pmid: 7800866
references.citation: BMC Bioinformatics. 2007 Jul 24;8:264
references.pmid: 17650333
references.citation: Arch Intern Med. 2004 Apr 12;164(7):785-92
references.pmid: 15078649
references.citation: BMJ. 2005 Apr 2;330(7494):765
references.pmid: 15767266
references.citation: J Biomed Inform. 2005 Dec;38(6):469-85
references.pmid: 16290243
references.citation: Arch Intern Med. 2003 Jun 23;163(12):1409-16
references.pmid: 12824090