@article{6563, author = {Gregory P T Scott and Priya Shah and Jeremy C. Wyatt and Boikanyo Makubate and Frank W. Cross}, title = {Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors.}, abstract = {

OBJECTIVE: Expert authorities recommend clinical decision support systems to reduce prescribing error rates, yet large numbers of insignificant on-screen alerts presented in modal dialog boxes persistently interrupt clinicians, limiting the effectiveness of these systems. This study compared the impact of modal and non-modal electronic (e-) prescribing alerts on prescribing error rates, to help inform the design of clinical decision support systems.

DESIGN: A randomized study of 24 junior doctors each performing 30 simulated prescribing tasks in random order with a prototype e-prescribing system. Using a within-participant design, doctors were randomized to be shown one of three types of e-prescribing alert (modal, non-modal, no alert) during each prescribing task.

MEASUREMENTS: The main outcome measure was prescribing error rate. Structured interviews were performed to elicit participants' preferences for the prescribing alerts and their views on clinical decision support systems.

RESULTS: Participants exposed to modal alerts were 11.6 times less likely to make a prescribing error than those not shown an alert (OR 11.56, 95% CI 6.00 to 22.26). Those shown a non-modal alert were 3.2 times less likely to make a prescribing error (OR 3.18, 95% CI 1.91 to 5.30) than those not shown an alert. The error rate with non-modal alerts was 3.6 times higher than with modal alerts (95% CI 1.88 to 7.04).

CONCLUSIONS: Both kinds of e-prescribing alerts significantly reduced prescribing error rates, but modal alerts were over three times more effective than non-modal alerts. This study provides new evidence about the relative effects of modal and non-modal alerts on prescribing outcomes.

}, year = {2011}, journal = {J Am Med Inform Assoc}, volume = {18}, pages = {789-98}, month = {12/2011}, issn = {1527-974X}, doi = {10.1136/amiajnl-2011-000199}, language = {eng}, }