In medication safety screening, alert fatigue occurs when the signal:noise ratio is so low that clinicians develop a habit of ignoring alerts, thereby potentially missing important alerts when they occur. One idea for reducing alert fatigue is to display relevant and recent lab results alongside the alert, thereby allowing physicians to make a more informed decision of the risk of a particular drug-drug interaction in a given patient. For example, if a drug-drug interaction may cause an increase in serum potassium (hyperkalemia), and if a patient’s serum potassium is already on the high side of normal, a physician may determine that it’s too risky to continue with the prescribed drug combination in this particular patient. Read further >
Vice President, Medical Informatics
Wolters Kluwer Health – Clinical Solutions
As the VP of Medical Informatics for Wolters Kluwer Health – Clinical Solutions, Howard focuses on building products that answer clinical questions and integrate knowledge with electronic medical record (EMR) and computerized physician order entry (CPOE) systems. He is also actively involved in standards development as a co-chair of the Health Level Seven (HL7) Clinical Decision Support (CDS) Technical Committee, which develops CDS standards in areas such as Infobuttons, order sets, and decision support services.
Prior to joining Wolters Kluwer Health in 2003, he was CEO of Skolar, Inc., an online provider of clinical information and "in context" continuing medical education (CME) for medical professionals.
Howard received his MD degree from the University of Western Ontario and his MS degree in Medical Information Sciences from Stanford University. He is board certified in Family Medicine. As a hobby, he enjoys following the airline industry, especially with regards to the latest schedules, routes, fares and frequent flyer programs.
Posts by Howard Strasberg
In a typical electronic health record (EHR), patient data are entered and stored using some combination of structured data (e.g. diagnosis codes) and free text. In general, analyses of EHR data focus on the structured data portion, which can be leveraged more easily by standard query tools, and which avoids some of the problems with free text, such as ambiguous terms and negation. Still, there’s a lot of useful information buried in the free text portions of these records. If there were some way to mine the free text, gold might well be discovered. Read further >
In the current issue of JAMIA, I along with my co-authors Guilherme Del Fiol and Jim Cimino describe various terminology challenges surrounding Infobutton implementations. I have frequently written about Infobuttons on this blog. In essence they are context-sensitive links from electronic health records (EHRs) to knowledge resources. Read further >
I have written several posts about how to address the problem of alert fatigue in medication safety screening. Alert fatigue occurs when the signal:noise ratio is so low that clinicians develop a habit of ignoring alerts, thereby potentially missing important alerts when they occur. Read further >
Regular readers of this blog will know that I frequently comment on the Health Level Seven International (HL7) Infobutton standard. Infobuttons are context-sensitive links from electronic health records (EHRs) to knowledge resources. Infobuttons were included in the 2014 EHR certification criteria (United States) under both clinical decision support (CDS) and patient education. Read further >
The medical informatics community has been trying to create a widely adopted standard for clinical decision support (CDS) artifacts for decades. While various standards do exist (e.g. Arden Syntax and GELLO), they haven’t been widely adopted. Perhaps the existing standard of greatest prominence is the Arden Syntax, which was the result of an informatics retreat in 1989 at the Arden Homestead in Harriman, NY. The Arden Syntax became an ASTM standard in 1992 and a Health Level Seven (HL7) standard in 1999. It has been adopted by a few of the major electronic medical record (EMR) vendors, but certainly not by all of them. Moreover, Arden suffers from what is known as the curly braces problem. The institution-specific portion of data retrieval is contained within curly braces, so institutions have to modify the content of the curly braces in order to be able to use Arden rules from external sources. Read further >
At the recent AMIA 2012 conference, I participated on a panel called Human Factors: The Science of Usability and Impact on Data Capture and Workflow. Given the critical patient safety role that healthcare IT systems play, more attention must be paid to the design and usability of these systems. Read further >
When patients are admitted to the hospital, attending physicians or their designates (e.g. interns and residents) must provide specific instructions on how the patient should be managed while in the hospital. These instructions are often provided through order sets, which are collections of requests for clinical activities, such as: Read further >
As I indicated on this blog in March, the HL7 Infobutton standard was included in the proposed rule for the 2014 EHR certification criteria. In the proposed rule, the use of this standard was required for both linked referential clinical decision support (CDS) and patient-specific education resources. Read further >
Medication safety screening is an important component of patient safety. A key challenge with this type of screening is alert fatigue, which is the tendency for providers to start to ignore alerts that are presented too often. Read further >