Michael A Krall

Publications of Michael A Krall

• Order sets in computerized physician order entry systems: an analysis of seven sites.

  Authors: Adam Wright, Dean F Sittig, James D Carpenter, Michael A Krall, Justine E Pang, Blackford Middleton

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2010; 2010:892-6.

  Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets areMost computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created. We analyzed order set utilization at seven diverse sites with CPOE. The number of order sets per site ranged from 81 to 535, and the number of order set uses per discharge ranged from 0.48 to 9.89. We also compared the top ten order sets at each site, and found many commonalities, such as generic and condition-specific admission order sets, surgical sets and clinical pathways. We also found that, at each site, utilization of order sets was skewed, with a small number of order sets comprising the bulk of utilization. These findings may be useful for order sets developers, particularly in settings where resources are constrained and the most important order sets must be developed first.

• A survey of factors affecting clinician acceptance of clinical decision support.

  Authors: Dean F Sittig, Michael A Krall, Richard H Dykstra, Allen Russell, Homer L. Chin

  BMC medical informatics and decision making. 01/2006; 6:6.

  BACKGROUND: Real-time clinical decision support (CDS) integrated into clinicians' workflow has the potential to profoundly affect the cost, quality, and safety of health care delivery. Recent reportsBACKGROUND: Real-time clinical decision support (CDS) integrated into clinicians' workflow has the potential to profoundly affect the cost, quality, and safety of health care delivery. Recent reports have identified a surprisingly low acceptance rate for different types of CDS. We hypothesized that factors affecting CDS system acceptance could be categorized as relating to differences in patients, physicians, CDS-type, or environmental characteristics. METHODS: We conducted a survey of all adult primary care physicians (PCPs, n = 225) within our group model Health Maintenance Organization (HMO) to identify factors that affect their acceptance of CDS. We defined clinical decision support broadly as "clinical information" that is either provided to you or accessible by you, from the clinical workstation (e.g., enhanced flow sheet displays, health maintenance reminders, alternative medication suggestions, order sets, alerts, and access to any internet-based information resources). RESULTS: 110 surveys were returned (49%). There were no differences in the age, gender, or years of service between those who returned the survey and the entire adult PCP population. Overall, clinicians stated that the CDS provided "helps them take better care of their patients" (3.6 on scale of 1:Never-5:Always), "is worth the time it takes" (3.5), and "reminds them of something they've forgotten" (3.2). There was no difference in the perceived acceptance rate of alerts based on their type (i.e., cost, safety, health maintenance). When asked about specific patient characteristics that would make the clinicians "more", "equally" or "less" likely to accept alerts: 41% stated that they were more (8% stated "less") likely to accept alerts on elderly patients (> 65 yrs); 38% were more (14% stated less) likely to accept alerts on patients with more than 5 current medications; and 38% were more (20% stated less) likely to accept alerts on patients with more than 5 chronic clinical conditions. Interestingly, 80% said they were less likely to accept alerts when they were behind schedule and 84% of clinicians admitted to being at least 20 minutes behind schedule "some", "most", or "all of the time". CONCLUSION: Even though a majority of our clinical decision support suggestions are not explicitly followed, clinicians feel they are of benefit and would be even more beneficial if they had more time available to address them.

• The electronic health record "toolbox".

  Authors: Michael A Krall

  The Permanente journal. 01/2005; 9(2):49-52.

• Effectiveness of an electronic medical record clinical quality alert prepared by off-line data analysis.

  Authors: Michael A Krall, Kati Traunweiser, William Towery

  Studies in health technology and informatics. 02/2004; 107(Pt 1):135-9.

  We tested whether off-line data analysis, instead of event monitoring, was a viable method for initiating a clinical quality alert. A cohort of patients eligible for an alert was identified byWe tested whether off-line data analysis, instead of event monitoring, was a viable method for initiating a clinical quality alert. A cohort of patients eligible for an alert was identified by off-line data analysis and a flag was set in their ambulatory Electronic Medical Records. One hundred clinicians were randomly assigned either to a control group or to a group that received the alert when viewing the electronic medical record of eligible patients. Primarily due to actions of their clinicians, 315 of the 580 patients (54.3%) seen by alerted clinicians were no longer eligible for the alert at the end of the one month study, compared to 128 of the 496 patients (25.8%) seen by control clinicians (p<.001). When not alerted, Allied Health clinicians were less likely than physicians to prescribe aspirin, but they responded similarly to the alert. There were no differences in response by specialty or gender of the clinician. Off-line data analysis proved to be an effective method of initiating a clinical alert.

• Clinician's assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements.

  Authors: Michael A Krall, Dean F Sittig

  Proceedings / AMIA ... Annual Symposium. AMIA Symposium. 02/2002;

  Electronic medical record alerts and reminders are increasingly employed as a means of decreasing medical errors and increasing the quality and cost-effectiveness of care. However, cliniciansElectronic medical record alerts and reminders are increasingly employed as a means of decreasing medical errors and increasing the quality and cost-effectiveness of care. However, clinicians indicate that alerts and reminders can be either help or hindrance. Discerning the elements that determine which they will be, and the requirements of a helpful alert or reminder, was the focus of this study. We convened three focus groups, comprised of a total of 16 participants. During analysis, five themes emerged: Efficiency, Usefulness, Information Content, User Interface, and Workflow. In addition there were some New Ideas and Surprises. Specific usability and usefulness requirements emerged from within the themes and these are described.

• Clinicians' assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements : a qualitative study : a dissertation /

  Authors: Michael A. Krall

  Abstract: leaf iii. Thesis (M.S.)--Oregon Health & Science University, 2002. Includes bibliographical references (leaves 92-96).

• Adapting Clinical Coding Systems for the Computer-Based Patient Record

  Authors: Homer L. Chin, Michael A Krall, Steven Lester

• Human Factors in Outpatient Decision Alerts and Reminders

  Authors: Michael A. Krall

  We report a simple experiment to better understand clinician perception of electronic alerts and reminders. A nonrandomized, opportunity sample of electronic medical record users completed a survey.We report a simple experiment to better understand clinician perception of electronic alerts and reminders. A nonrandomized, opportunity sample of electronic medical record users completed a survey. Results suggest clinicians identify limits to “optimal” and “maximal” number of theoretical alerts and reminders. Limits are greater for higher priority alerts. Clinicians require greater accuracy from more critical alerts.

• Clinicians' assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements : a qualitative study.

  Authors: Michael A. Krall

  M.S. Medical Informatics and Outcomes Research Abstract Electronic medical record alerts and reminders are increasingly relied upon as a means of decreasing medical errors and increasing the qualityM.S. Medical Informatics and Outcomes Research Abstract Electronic medical record alerts and reminders are increasingly relied upon as a means of decreasing medical errors and increasing the quality and cost-effectiveness of care. They may serve as useful memory aids and draw attention to a variety of situations in which safety, quality, or optimal utilization of scare resources might otherwise be compromised. However, clinicians indicate that alerts and reminders can either help or hinder. Discerning the elements that determine which they will do, and the requirements of a helpful alert or reminder was the focus of this study. Three focus groups consisting of a total of 16 participants were convened. These included 10 male and 6 female primary care clinicians. There were 3 pediatric, 8 family medicine, and 5 internal medicine specialists, 13 physicians, 2 physician assistants, and nurse practitioner. The mean duration of time with Kaiser Permanente was 9.5 years, with a range of from 1 to 24.5 years. All participants had access to the electronic medical record in their exam rooms. Focus groups were recorded and transcripts were iteratively coded and analyzed for themes that would help illuminate characteristics of a helpful alert or reminder. Five themes emerged: Efficiency, Usefulness, Information Content, User Interface, and Workflow. In addition there were New Ideas and Surprises. Following a question-by-question summary of responses, each theme is described in detail and supported with illustrative excerpts. This is followed by a summation of requirements and further discussion.