title: The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network.
abstract: The nature, variability, and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently used in acute care settings for clinical care or research is unknown.
  
  
  
  To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network.
  
  
  
  We surveyed investigators at 38 institutions involved in the National Institutes of Health-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis.
  
  
  
  Thirty sites completed the survey (79% response rate). All sites used electronic health record systems. Epic Systems was used at 56% of sites; the others used alternate commercially available vendors or homegrown systems. Respondents at 57% of sites represented in this survey used e-alerts. All but 1 of these 17 sites used an e-alert for early detection of sepsis-related syndromes, and 35% used an e-alert for pneumonia. E-alerts were triggered by abnormal laboratory values (37%), vital signs (37%), or radiology reports (15%) and were used about equally for clinical decision support and research. Only 59% of sites with e-alerts have evaluated them either for accuracy or for validity.
  
  
  
  A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Cody
authors.initials: C
authors.lastname: Benthin
authors.affiliation: 2 Division of Pulmonary, Critical Care, Allergy, and Sleep, Ohio State University Medical Center, Columbus, Ohio; and.
authors.forename: Sonal
authors.initials: S
authors.lastname: Pannu
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Akram
authors.initials: A
authors.lastname: Khan
authors.affiliation: 3 Division of Critical Care, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Michelle
authors.initials: M
authors.lastname: Gong
mesh_terms: D035843:Biomedical Research; D000066491:Clinical Decision-Making; D003422:Critical Care; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D006801:Humans; D011014:Pneumonia / Q000175:diagnosis; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000175:diagnosis; D018805:Sepsis / Q000175:diagnosis; D011795:Surveys and Questionnaires; D014481:United States
keywords: acute respiratory distress syndrome; electronic health record alerts; sepsis; survey