EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.
In 2013, 24 hours after she receives a live, attenuated influenza vaccine, Juana Maria Gonzales Morales had fever and diarrhea. When Dr. Smith’s associate sees Juana Maria in 2015, he can view her possible adverse event as part of the immunization record.
All systems reviewed allow entry of allergy and adverse reactions in the allergy list and/or on the patient’s problem list. Less clear is the ability to ensure a user is aware of an adverse reaction to the antigen recommended by a forecast or an antigen about to be ordered or administered. Feedback to users about potential patient risks can be provided specific to the level of risk. Types of feedback defined in the context of software usability include:[i]
- Notification: A notification is a visual clue or displayed message that informs a user but does not require any action (examples include visual clues such as a persistent banner, color change, bolding, etc. (E.g., “This patient is allergic to ___”).
- Alert: An alert or warning is displayed when user action may result in unintended consequences, for example loss of data, etc. These types of messages shall require the user to acknowledge the message before they can move on (e.g., click ok)
- Errors: Error message should be displayed in plain language describing specific error condition and instructions what steps a user need to take. This condition requires the user to fix something before they can move on (e.g., fix this date, it is invalid).
Notification in this context indicates that the system provides indication so the user is aware of a potential problem including the severity of previous reactions. Notification should include information, if available, about prior decisions, e.g. if a provider documented a reason to override notification about allergy or diagnosis in the past. The method for fulfilling the requirement is not prescriptive. Examples of notification include visual clues.
- Vendor Perspectives. Vendors should consider usability evaluation such as User Centered Design (UCD) to evaluate how the system handles notifications and alerts.
- Provider and Implementer Perspectives. Notifications and alerts can be a significant usability issue in EHRs. Providers should consider participating in vendor activities to address timely and appropriate notification.
Click here for test plans that include the capability, Notify of Previous Adverse Event. The scripts indicate successful performance for each of the test sections. The notification must be visible directly on the ordering and the documentation screens specific to the vaccine ordered or documented.
The data elements include the adverse reaction specific to the clinical scenario in the test script.
[i] Lowry JC, Fingerman PW. ECS User Interface Style Guide. January 1996. Available at:http://www.deepsloweasy.com/HFE%20resources/Hughes%20EOS%20CHI%20Guidebook.pdf. Accessed 22 September 2015.