New ReScript alert: risk of alert fatigue and lack of collaboration?

Discussions
1

Kia ora team

I am hoping this is the right place to find answers to a problem that has kind of led me down a rabbit hole. Disclaimer: GP and ethicist focusing on digital health ethics.

In my GP role, I noticed a new alert in ReScript since a month or two, stating: “Nudge! Suspected similar medication prescribed in the past 7 days, check shared medical records”. This means opening HealthOne, going through the ‘break the glass’ statement declaring that I am involved in the patient’s care and need to see the medication list (just to say, it takes a moment), and checking the lists of prescribed and dispensed medications, only to conclude the same medication was not prescribed, but dispensed in the last 7 days. So, any patient who picked up their last script and then asked for a repeat within a week, or has weekly dispensing for example, would have an alert pop up. I am interested in alert fatigue, so I discussed this with our manager who flagged it with ReScript.
Their response (today) was: “Our developer recommends that the GP looks into NZePS for ALL medications prescribed and dispensed, not only on your system, as it only flags when multiple providers prescribed or dispensed this same treatment”.

Does this mean that I need to check HealthOne (ie the shared record) every time I provide a script or am I understanding this incorrectly? And moreover, why would it flag dispensed medication in an alert meant to flag prescribed medication? At this point, it results in a useless alert, and that is a pity since it is a missed opportunity. I’d like to be notified when the same medication has been prescribed in the last 7 days. Coincidentally, I used this example in a presentation to GPs in training (GPEP1) two weeks ago and most had either not seen or ignored the alert. I should do a survey in our clinic to see who has picked up on it and checked it.

This does add to my recent experience that it is really hard to discuss such issues with vendors/industry partners. We have an ongoing issue in MedTech with the lab result cumulative view that still has not been sorted after over 6 months. So side question under collaborations here: am I missing the clinicians’ user groups, co-design, other collaborations somehow? How can we solve the disconnect between IT development and implementation, and users? Either I am missing existing collaborative groups and initiatives, and then there is a problem with communication, or they do not exist, and then we have an even bigger issue of needing to bridge the gap.

I’d love to hear your input on both the current alert issue, as well as the underlying question of co-design and collaboration!

Kia pai tō rā
Tania

3 Likes
2

Kia ora @Tania - Thank you so much for highlighting this really important user-experience situation!!! I, too, share your concerns and you describe precisely the actual general-practice clinical-workflow and alert-fatigue.

Initially, ReScript was such a useful alert when I needed to change patients from Cilazapril and I think ReScript managed to find the last few patients that we had missed . . . so, that was an example of a fantastic alert that made clinical difference from my perspective. That particular alert also helpfully had a one-click hyperlink to a BPac table with equivalent doses. In summary: the perfect UX alert that improved a focused clinical situation.

But, I too, have been ignoring the ‘similar medications’ alert and delegated that to my list of ‘alert fatigues’ I’ve decided to ignore. For, exactly the reasons you’ve outlined . . . I’m in Bay of Plenty, so it’s not HealthOne, but rather Regional Midland Clinical Portal . . . AND, I’m lucky to have hospital-level access to see the NZePS screen because my practice is Te Whatu Ora owned/operated . . . but, most GPs in my region can’t easily see this . . . they’d have to go via PathLab eClaire with tons of clicking around for ‘community dispensing’ . . . I cannot imagine many are doing this. Thus, like myself, I’m assuming most GPs never even explored and figured out what you took the time to do. . . . what the alert was even about (e.g., dispensing, not prescribing). Conversely, I wonder if there have been prescriptions NOT done because of the alert, taken at face-value, which generates patients not getting scripts and might have clinical negative outcomes!

In conclusion, though ReScript has been invaluable and specific alerts helpful, clearly the co-design of what alerts are developed and how, need alot more user input.

The above is, I’m afraid, a terrible response and arguably, is in contradiction to legislated Code of Expectations given we, users, are an integral part of the ‘consumer’ experience.

We also need the Pharmacy input about this issue. Who is responsible for ensure the Code of Expectations is implemented for exactly this sort of situation? Perhaps this is the role that falls under the Whānau, Consumer, and Clinician Digital Council? https://www.tewhatuora.govt.nz/our-health-system/digital-health/whanau-consumer-and-clinician-digital-council/ Perhaps @karl , and, @Nclarkemd , as 2 GPs on that council can guide us? Or, anyone else involved in that council? (@lara , @karenshaw, etc?)?

Finally, this is an excellent example of a topic that we need a place to discuss, with this forum being the logical place for GPs whose workplaces are across so many organizations, meaning Teams is not an option . . .and there are many problems with the default Facebook groups. Multiple attempts have been trialed to build an active GP forum here, but have failed from lack of engagement. There is a GP Group, but sometimes, GP topics like this may be better in the open forum so everyone can see our issues :wink:

3 Likes
3

Hmm yes I find rescript frustrating to use but i have been told that is the best option for medtech pms users.
Any other experience out there with eprescribing on different pms systems? I get the impression that Indici has better UX in this regard.
In Canterbury we can view prescribing & dispensing via HealthOne but it would be nice if this could be shown directly within the PMS e.g. via API.
I also wonder about a shared community platform for prescribing - similar to the ideas shared by @NathanK on ehr discussions Deep discussion about EPRs and the way forwards on the DHN

2 Likes
4

Thanks Emily, and I agree: overall ReScript works really well, and my post was in no means meant to say it doesn’t. The cilazapril example is a good one! The lack of interoperability is indeed problematic and leads to inefficiencies (I still use an article from 2013 as an example for students, saying ED doctors need about 4000 clicks to get through a busy 10-hour shift, I don’t think this has come down in the past decade).
@mca This is also what you are referring to with direct integration of HealthOne in the PMS.

This example did make me wonder about co-design and clinician-informatics collaborations. I am a GP and ethicist so look at things from that specific angle, but clinical informaticians on this forum may have a better idea about what platforms/forums/groups/other are currently being used. I’d be keen to learn more! Recent experiences with giving feedback to vendors as a clinician have not been great, which makes me wonder whether things are getting lost in translation somehow. What can we do to improve this? I am part of the GP group but have not been very active there, so maybe that’s a start :wink:

2 Likes
5

Many NZ systems were initially co-designed with clinicians but, when market share grows, the suppliers begin to adopt a ‘product centric’ perspective and are loathe to make user interface (UI) changes. It’s also fair to say that it is challenging to gain consensus among a group of clinicians (particularly specialists) on UI features and workflows. A similar challenge would be faced if those designing consumer views attempted co-design with a large cohort. HL7 International has an EHR Workgroup that produces functional standards, but has always met with large resistance when even just discussing UIs. The suppliers view this as one of their main points of differences with their competitors. However, I do think that some standardisation is required in highly-regulated (and high risk) areas such as e-Prescribing.

4 Likes