Journal of Health & Medical Informatics

Clinician Acceptance of Computerized Alerts for Public Health Surveillance

Abstract

Teeb Al-Samarrai1,Carolyn Greene,Lorna Thorpe,Elizabeth Begier

Background: With expansion of electronic health records, there is an increasing role for clinical decision support (CDS) alerts, however their acceptability for public health surveillance has not been studied. We surveyed primary care providers (PCPs) and nursing staff at nine clinics in New York City where a pilot respiratory virus surveillance system was implemented. Purpose: Evaluate acceptability of CDS alerts encouraging diagnostic testing for respiratory viruses. Methods: The pilot surveillance system was implemented at nine outpatient clinics in New York City. An evaluation of the first 5 weeks of operation, May 26–June 30, 2009, was performed. Online surveys for PCPs (N=45) and nursing staff (N=47) were developed and sent electronically 5 months after surveillance system implementation. Significance testing was performed using Fisher’s exact test. Results: The survey response rate was 53% (n=24) for PCPs and 55% (n=26) for nursing staff. Nursing staff were significantly more likely to report adherence to CDS alerts than PCPs. PCPs and nursing staff had statistically significant differences in their perceptions of the clinical utility of diagnostic testing. PCPs primarily attributed nonadherence to low clinical utility of diagnostic testing, whereas nursing staff primarily attributed it to lack of PCP orders. Discussion: Low threshold for CDS alert triggers, low sensitivity of diagnostic testing, and prioritization of clinical utility over surveillance objectives contributed to suboptimal adherence among both PCPs and nursing staff to CDS alerts. Conclusion: PCPs and nursing staff perceive and adhere to CDS alerts differently. Future public health surveillance systems should choose user-centered frameworks in designing and implementing CDS alerts, provide training regarding surveillance objectives, consider targeting CDS alerts to the initial encounter between patient and nursing staff, and conduct periodic evaluations of adherence and acceptability.