Alerts
Alerts are one of the 5 major types of Clinical Decision Supports, together with references, reminders, assists and guides. Alerts algorithmically detect clinically important associations between data and events found in the digital health record and bring these to the attention of clinicians, often together with recommended actions.
Alerts can be passive, when the clinician solicits, obtains and decides to act upon alert advice. When active, alerts interject into workflows to bring information to the attention of a provider who may not have been seeking it. Finally, directive alerts suggest actions in a way that the clinician must respond to.
Connect Care supports a number of different types of alerts:
Best Practice Advisories (BPAs) are based on rules that analyze information in patients' charts and generate recommendations for consideration by the clinician.Â
Medication alerts highlight possible drug-drug, drug-disease, drug-lab-result or drug-allergy associations, usually during medication ordering or review workflows.
Storyboard alerts appear in a section of the patient chart storyboard (leftmost column), visually highlighting things like falls and suicide risks.
Minimum use alerts (checklists) appear in the default view of all inpatient chart sidebars, highlighting actions that should be taken to comply with minimum use norms.
The meaning of most alerts is obvious. Some have unique behaviours or implications, as summarized here.
Chronic Disease Management (Care Path) Advisories
Care Paths are among the "guidance" type of Clinical Decision Supports. They help clinicians to organized evidence-informed goal-directed care across person, place and time.
Care Paths make extensive use of Best Practice Advisories (BPA). They may be silent (working in the background), passive (shaping the information clinicians see without prompts), active (offering simple suggestions) or directive (making clinically important recommendations that the clinician must manage). Care Path BPAs use a consistent presentation format and so examples are illustrative of their functions.
Suicide Risk Alerts
Suicide risk screening occurs as part of standardized workflows when patients are seen in emergency departments, detoxification centres, certain residential treatment facilities, many long-term care departments and a number of inpatient settings. Risk stratification is based upon patient answers to questions (Columbia Suicide Severity Rating Scale, C-SSRS, available in the scores section of inpatient chart sidebars) and clinician observations (captured in a suicide risk assessment flowsheet combined with the C-SSRS, also available through the scores sidebar).
If patient and/or clinician responses meet criteria for high suicide risk, a best practice advisory (BPA) is triggered for the clinician documenting pertinent information. This alert contains guidance about steps to take when confronted with a high-risk scenario. In addition, a Storyboard alert appears in bright red when a patient is found to present a high suicide risk. This is visible to all Connect Care clinicians, in all contexts. The Storyboard alert can be selected (double click) to reveal more information about when and how the high-risk determination was made. The same popup contains links to the risk screening tools where updated data can be entered, possibly changing the risk strata assigned.
When moderate suicide risk criteria are met, the documenting clinician receives a BPA with guidance. The Storyboard alert does not show.