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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1009 — CPRS-Based “View Alerts” Received by VA PCPs: How Many and How Much Time Do They Take?

Murphy DR, and Reis BA, Houston VA HSR&D Center of Excellence; Sittig DF, University of Texas School of Biomedical Informatics; Singh H, Houston VA HSR&D Center of Excellence;

Objectives:
CPRS-based “View Alert” notifications are increasingly used to communicate important clinical information to providers asynchronously, i.e. when sender and receiver are not simultaneously engaged. We sought to quantify and categorize asynchronous alerts (also known as CPRS Notifications) according to the information they conveyed and measured their impact on primary care provider (PCP) workload.

Methods:
We queried an alert tracking file to extract alert information transmitted to all 47 PCPs at a large, tertiary care Veterans Affairs facility over 4, evenly spaced 28-day periods between 7/29/2009 and 5/25/2010. We performed a content analysis to categorize asynchronous alerts according to the information they conveyed and used these findings to develop an alert taxonomy. Using the taxonomy, we then quantified the number of alerts of each type and calculated the mean number of alerts PCPs received each day. We subsequently conducted a time-motion study and observed 26 PCPs while they processed their alerts. We used these data to estimate the uninterrupted time practitioners spent in processing their alerts each day.

Results:
We extracted 295,792 asynchronously-generated alerts and created a taxonomy of 33 unique alert types organized within six major categories: Test Results, Referrals, Note-Based Communication, Order Status, Patient Status Changes, and Incomplete Task Reminders. PCPs received a mean of 56.4 alerts/day containing new information. On observation of 749 alert processing episodes, practitioners spent an estimated average of 49 minutes/day processing their alerts.

Implications:
PCPs receive a large number of asynchronous alerts each day via CPRS and spend a substantial amount of time processing them.

Impacts:
Electronic health record-based notification systems must balance providing sufficient information to make informed decisions without overburdening practitioners to the point of information overload. The utility of transmitting large quantities and varieties of alerts to PCPs warrants further investigation.


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