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. 2015 Summer;19(3):11-9.
doi: 10.7812/TPP/14-227. Epub 2015 Jun 1.

A Metrics Taxonomy and Reporting Strategy for Rule-Based Alerts

Michael Krall  1 , Alexander Gerace  2
Affiliations

A Metrics Taxonomy and Reporting Strategy for Rule-Based Alerts

Michael Krall et al. Perm J. 2015 Summer.

Abstract

An action-oriented alerts taxonomy according to structure, actions, and implicit intended process outcomes using a set of 333 rule-based alerts at Kaiser Permanente Northwest (KPNW) was developed. The authors identified 9 major and 17 overall classes of alerts and developed a specific metric approach for 5 of these classes, including the 3 most numerous ones in KPNW, accounting for 224 (67%) of the alerts.

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Figures

Figure 1.
Figure 1.
Distribution of alerts at Kaiser Permanente Northwest by class, 2013.
Figure 2.
Figure 2.
Substitute Order Alert with example report: “X” is the procedure that triggered the best-practice alert, “Y” the recommended substitute order, “X+Y” represents encounters in which both tests were ordered and “none” in which neither test was ordered. © 2014 Epic Systems Corporation. Used with permission. FT4 = free thyroid; T4 = thyroid hormone; TSH = thyroid stimulating hormone; W = with.
Figure 3.
Figure 3.
Corollary-type alerts and report. A referral to nephrology for evaluation of acid-base disturbance generated these alerts for tests recommended before the referral that have not been performed. In the report, “X” is the procedure that triggered the best-practice alert, “Y” the recommended additional order(s); “X+Y” represents encounters in which both tests were ordered: the desired result in this case. © 2014 Epic Systems Corporation. Used with permission. BUN = blood urea nitrogen; CA = calcium; CBC = complete blood count; CL = chloride; CO2 = carbon dioxide; CR = creatinine; ED = Emergency Department; EKG = electrocardiogram; GLU = glucose; K = potassium; KPNW = Kaiser Permanente Northwest; NA = sodium; REF = referral; TSH = thyroid stimulating hormone; UA = urinalysis.
Figure 4.
Figure 4.
Substitute Medication Alert and attached ambulatory order set. A benzodiazepine drug was ordered in a patient older than age 64, and a substitution is recommended and facilitated via the attached ambulatory order set containing condition-specific recommended alternatives. Note that there are both pharmacologic and nonpharmacologic alternatives. The anxiety treatment options are in an expandable group. Each of these choices is contained in a separate group or item within the database. © 2014 Epic Systems Corporation. Used with permission. AVS = after-visit summary; Disp-30 = dispense 30; Hx=history of; HEDIS = Healthcare Effectiveness Data and Information Set; OTC = over the counter; PO = by mouth; PRN = when necessary; R-5 = refill 5 (ie, 5 refills).
Figure 5.
Figure 5.
Substitute Medication Alerts with results. “X” is the medication that triggered the alert, “Y” is the recommended substitution medication. “X+Y” represents encounters in which both medications were ordered. This report also indicated whether the medication was ordered via an ambulatory order set or via an attached single order (SingOrd). PO = by mouth; TCA = tricyclic antidepressant.
See this image and copyright information in PMC

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