A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.
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.
Phansalkar
Shobha
S
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. sphansalkar@partners.org
Edworthy
Judy
J
Hellier
Elizabeth
E
Seger
Diane L
DL
Schedlbauer
Angela
A
Avery
Anthony J
AJ
Bates
David W
DW
D006804:Ergonomics / Q000379:methods*; D006751:Hospital Information Systems / Q000458:organization & administration*; D006801:Humans; D050316:Medical Order Entry Systems
Qual Saf Health Care. 2004 Jun;13(3):186-90
15175488
Qual Saf Health Care. 2006 Apr;15(2):81-4
16585104
Ergonomics. 1995 Nov;38(11):2188-206
7498184
J Am Med Inform Assoc. 2007 Jan-Feb;14(1):29-40
17068355
Hum Factors. 2004 Spring;46(1):11-31
15151153
Ergonomics. 1995 Nov;38(11):2207-20
7498185
J Am Med Inform Assoc. 2002 Nov-Dec;9(6 Suppl):S75-7
12386188
Risk Anal. 1994 Oct;14(5):789-98
7800863
JAMA. 1998 Oct 21;280(15):1311-6
9794308
Arch Intern Med. 2003 Nov 24;163(21):2625-31
14638563
Stud Health Technol Inform. 2004;107(Pt 2):1063-7
15360975
Am J Health Syst Pharm. 2001 Aug 1;58(15):1428-31
11494789
Proc Annu Symp Comput Appl Med Care. 1994;:996
7950101
J Biomed Inform. 2004 Jun;37(3):193-204
15196483
J Biomed Inform. 2004 Feb;37(1):30-42
15016384
Int J Med Inform. 2008 Jun;77(6):365-76
18023611
Comput Biomed Res. 1989 Dec;22(6):575-87
2686930
J Am Med Inform Assoc. 2004 Nov-Dec;11(6):482-91
15298998
J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313-21
10428004
BMJ. 2004 May 15;328(7449):1171-2
15142922
J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12
14633936
J Appl Psychol. 1967 Oct;51(5):417-25
6074392
Ergonomics. 1995 Nov;38(11):2300-12
7498189
Ergonomics. 1970 Jan;13(1):101-17
5416864
Proc AMIA Symp. 2000;:2-6
11080034
J Biomed Inform. 2001 Feb;34(1):52-66
11376543
J Am Med Inform Assoc. 2006 Jan-Feb;13(1):5-11
16221941
Ergonomics. 2000 Sep;43(9):1283-300
11014752
Proc AMIA Annu Fall Symp. 1996;:704-8
8947756
Am J Infect Control. 2005 Oct;33(8):439-43
16216656
Risk Anal. 1994 Oct;14(5):779-88
7800862
Health Serv Res. 2008 Feb;43(1 Pt 1):32-53
18211517
J Am Med Inform Assoc. 2009 Jan-Feb;16(1):40-6
18952941
BMJ. 2000 Mar 18;320(7237):750-3
10720357
J Am Med Inform Assoc. 2006 Mar-Apr;13(2):138-47
16357358
Stud Health Technol Inform. 2004;107(Pt 2):1101-5
15360983
Int J Med Inform. 2005 Aug;74(7-8):615-22
16043086
Risk Anal. 1994 Oct;14(5):815-28
7800866
BMC Bioinformatics. 2007 Jul 24;8:264
17650333
Arch Intern Med. 2004 Apr 12;164(7):785-92
15078649
BMJ. 2005 Apr 2;330(7494):765
15767266
J Biomed Inform. 2005 Dec;38(6):469-85
16290243
Arch Intern Med. 2003 Jun 23;163(12):1409-16
12824090