'Idiot,' 'dumb': Partners HealthCare flags 'cranky' comments to improve EHR alerts

Partners HealthCare in Boston is trying a new method to improve clinical decision support in its EHR, according to a study published in the Journal of the American Medical Informatics Association.

Clinical decision support alerts seek to analyze EHR data to inform patient care, for example, by identifying potentially dangerous drug interactions or potential medications to prescribe. However, these alerts can malfunction — and many hospitals don't have tools in place to discover when clinical decision support alerts aren't working correctly.

To address this issue, researchers from Partners HealthCare and its affiliated Brigham and Women's Hospital decided to analyze the text comments physicians sometimes submit after overriding a clinical decision support alert. Their goal was to see whether a look at override comments could suggest which alerts were in need of review.

The researchers analyzed how frequently physicians used "cranky" words — such as "dumb," "idiot" and "please stop" — along with how frequently an alert received override comments to rank which alerts may be malfunctioning.

In total, the researchers said override comments helped identify malfunctions in 26 percent of the health system's alerts.

"Override comments are a rich data source for finding alerts that are broken or could be improved," the study authors wrote. "Even for low-resource organizations, reviewing comments identified by the cranky word list heuristic may be an effective and feasible way of finding broken alerts."

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