Table 2.
Pilot study – provider responses by site and by DGI
| Alert Response |
Clinical Response |
|||||||
|---|---|---|---|---|---|---|---|---|
| Site / DGI | Total Alerts | Accept | Override | Ignore | Unknown | Followed | Not Followed | No Action |
| Cincinnati Children’s | 114 | 102 (89%) | 0 (0%) | 10 (9%) | 2 (2%) | 69 (61%) | 18 (16%) | 27 (24%) |
| Marshfield Clinic | 40 | 39 (98%) | 0 (0%) | 1 (3%) | 0 (0%) | 17 (43%) | 23 (58%) | 0 (0%) |
| Mayo Clinic | 9 | 4 (44%) | 0 (0%) | 5 (56%) | 0 (0%) | 4 (44%) | 5 (56%) | 0 (0%) |
| Mt. Sinai | 11 | 8 (73%) | 3 (27%) | 0 (0%) | 0 (0%) | 8 (73%) | 1 (9%) | 2 (18%) |
| Northwestern | 22 | 9 (41%) | 0 (0%) | 13 (59%) | 0 (0%) | 5 (23%) | 14 (64%) | 3 (14%) |
| Vanderbilt | 98 | 21 (21%) | 72 (73%) | 5 (5%) | 0 (0%) | 21 (21%) | 65 (66%) | 12 (12%) |
| Total by Site | 294 | 183 (62%) | 75 (26%) | 34 (12%) | 2 (1%) | 124 (42%) | 126 (43%) | 44 (15%) |
| Codeine | 114 | 102 (89%) | 0 (0%) | 10 (9%) | 2 (2%) | 69 (61%) | 18 (16%) | 27 (24%) |
| Clopidogrel | 65 | 14 (22%) | 46 (71%) | 5 (8%) | 0 (0%) | 10 (15%) | 40 (62%) | 15 (23%) |
| Simvastatin | 24 | 22 (92%) | 1 (4%) | 1 (4%) | 0 (0%) | 11 (46%) | 13 (54%) | 0 (0%) |
| Warfarin | 91 | 45 (49%) | 28 (31%) | 18 (20%) | 0 (0%) | 34 (37%) | 55 (60%) | 2 (2%) |
| Total by DGI | 294 | 183 (62%) | 75 (26%) | 34 (12%) | 2 (1%) | 124 (42%) | 126 (43%) | 44 (15%) |
Alert response varied across sites. Variation in response rate is likely due to significant differences in alert design. As a result, it is difficult to draw any broad conclusions about how physicians are responding to PGx CDS alerts in general. Instead, it will be necessary to analyze alert response in relation to the different design choices made at each site to understand how those choices influence physician behavior.
Definitions.
Alert Response: How the clinician responded to the actual alert that appeared in the EHR interface.
Clinical Response: How the clinician behaved in caring for the patient after viewing the alert.
Accept: Provider explicitly used the CDS-provided “accept” functionality to dismiss an alert.
Override: Provider explicitly used the CDS “acknowledge” or “override” functionality to dismiss an alert.
Cancel: Provider closed an alert without interacting with its contents.
Followed: Provider performed the recommended action within a pre-defined time window after seeing an alert.
Not Followed: Provider performed a clinically relevant, but not recommended, action within a pre-defined time window after seeing an alert.
No Action: Provider performed no clinically relevant action within a pre-defined time window after seeing an alert.