The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network

Headnote

Abstract

Rationale: 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.

Objectives: To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network.

Methods: 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.

Measurements and Main Results: 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.

Conclusions: 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 maybe possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

Keywords: sepsis; acute respiratory distress syndrome; electronic health record alerts; survey

The rapid implementation of electronic health records (EHR) in the last decade has allowed the application of automated electronic alerts (e-alerts) to improve the processes of care by providing clinical decision support, facilitating recruitment in clinical trials, and improving the reporting of quality measurements (1-4). Outside of acute care settings (emergency medicine, trauma care, prehospital emergency care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization) (5), e-alerts have been widely used (6, 7) and have improved enrollment in clinical trials (8).

In acute care...