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Bernie Monegain


A consolidated architecture that combines patient data EHR with medication information could enable more informative and actionable medication alert systems, Charlie Hart says.


Charlie Hart, a pharmacy informaticist at Mercy Health, a four-hospital health system in northern Illinois and southern Wisconsin, is advocating for a rethink of medical alerts. He envisions alerts that are so relevant they would no longer be ignored.

Hart advocates alerts at the most effective point in the workflow and for integrating information from the electronic health record, with a drug knowledge database. As he sees it, this makeover would reduce nuisance alerts. Instead, warnings would provide guidance to boost clinical care.

"The EHR contains a wealth of information about the patient," he said.

But the problem is that traditional medication alerts do not leverage most of this EHR information. Vendors can be slow to program new functionality, he said, because they have a 12-to-18-month release cycle and they need to support multiple drug database products.

In turn, this makes it hard for the EHR vendor to develop and support additional advanced medication alerts features that are not supported by all drug database vendors.

Hart suggested employing a consolidated clinical document architecture to combine the patient information from the EHR and the critical medication information from the drug vendor database vendor. Those steps would allow for the integration of patient-specific information into medication alert systems.

What information is often lacking for caretakers? Traditional medication alerts are triggered by the medication, Hart pointed out.

"Basic patient information like age, sex, comorbidities and key labs are not evaluated when deciding if a medication alert is applicable to the patient and should be displayed to the clinician," he explained.

So Hart champions more specific medical alerts.

Traditional drug-to-drug interactions evaluate drug pairs, and if two drugs are known to interact with a high enough severity, an interruptive alert will be displayed to the clinician, he said.

When assessing the drug-to-drug pair, key patient information is not evaluated, Hart added. However, by incorporating these additional patient-specific factors, the decision to display an interruptive alert to a clinician can be more precise and more specific to the patient.

Hart is scheduled to present at the HIMSS18 session, “Zeroing in on the patient to reduce alert fatigue,” at noon March 9 in the Venetian, Murano 3304.