[leonth]

I completely agree, although the attitude at facilities where this has been done extensively is always "how can we reduce the alert/popup/notification burden" because it always invariably slows things down and annoys people. And after a while the muscle memory stuff comes in as well - a typical alert can pop up tens of times a day with very high false positive rate.

An automated "checklist generation" is easy via subscription to data vendors, whereas manual curation takes years (even when only codifying best practices). And we can't just have one set of alerts for the world because everyone's (patient demographics, risk appetite, clinical sophistication level, computer skills, political situation) is different.

[petra]

>> And after a while the muscle memory stuff comes in as well - a typical alert can pop up tens of times a day with very high false positive rate.

Do the best tools able to solve this in a satisfactory manner(the tool issue, the organizational issue) ? How ?

>> whereas manual curation takes years (even when only codifying best practices)

Can't this be done in parallel ? and why are resources an issue for such an important thing with a clear health ROI and maybe financial ROI ?

[leonth]

> Do the best tools able to solve this in a satisfactory manner(the tool issue, the organizational issue) ? How ?

The best solution is I believe relentless continuous manual curation, which is discussed below. Automated tools are rather frowned upon in this area because I don't think there is any that is good enough until everyone is comfortable to rely on the black box.

> Can't this be done in parallel ? and why are resources an issue for such an important thing with a clear health ROI and maybe financial ROI ?

It definitely can be done in parallel. It takes years mainly due to political issues - like doctors arguing against each other which treatment/alert/option is the best, doctors/nurses/pharmacists arguing against each other who needs to look out for certain alerts, etc. We are not talking about tens of alerts, the number usually comes up to thousands.

Resource is an issue here because the best people to manually curate are the healthcare professionals themselves, but they are usually, you know, treating patients, so they are hard to find on their desks. And as mentioned elsewhere, the industry is highly hierarchical, so a bunch of minions can propose changes to alerts but everything needs to go to some higher authorities because the stakes are too great. Sometimes this "higher authority" does not decide without a formal consultation with some other authority. (nobody wants to be blamed if an error happens because the hospital just removed a perceived low-quality alert a week ago)

Coupled with the need to perform lots of research to produce high quality alerts, I would presume only large-ish hospitals / clusters (perhaps > 1000 combined bed capacity) can afford full-time people to look into this.

[petra]

Thanks for the detailed response.

So it's hard to get the resources in a single hospital, what about collaboration across hospitals or even the department of health ? Seems like a worthwhile goal.