Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 7, 2020
Date Accepted: Sep 12, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Reducing alert fatigue by sharing low-level alerts with patients and enhancing collaborative decision-making using blockchain technology: Review and proposed framework (MedAlert)
ABSTRACT
Background:
Clinical decision support (CDS) is a tool that helps clinicians in decision-making by generating clinical alerts to supplement their previous knowledge and experience. However, CDS generates a high volume of irrelevant alerts, resulting in alert fatigue among clinicians. Alert fatigue is the mental state of alerts consuming too much time and mental energy, which often results in relevant alerts being overridden unjustifiably, along with clinically irrelevant ones. Consequently, clinicians becoming less responsive to important alerts, which opens the door to medication errors.
Objective:
The research question is set to explore how a blockchain-based solution can reduce alert fatigue through collaborative alert sharing in the health sector, thus improving overall healthcare quality for both patients and clinicians.
Methods:
We have designed a four-step approach to answer our research question. First, we identify five potential challenges based on the published literature through a systematic literature review. A framework is then designed to reduce alert fatigue by addressing the identified challenges with different digital components. Thirdly, an evaluation is made by comparing MedAlert with other proposed solutions. The limitations and future work are also discussed.
Results:
MedAlert securely distributes low-level (non-life-threatening) clinical alerts to patients enabling a collaborative clinical decision. Among the solutions in our framework, Hyperledger (private blockchain) and BankID (federated digital identity management) have been selected in order to overcome challenges such as data integrity, user identity and privacy issues.
Conclusions:
MedAlert can reduce alert fatigue by attracting the attention of patients and clinicians, instead of solely reducing the total number of alerts. MedAlert offers other advantages, such as ensuring a higher degree of patient privacy and faster transaction times when compared with other frameworks. This framework may not be suitable for elderly patients who are not technology-savvy or in-patients. Future work in validating this framework based on real healthcare scenarios is needed to provide the performance evaluations of MedAlert and thus gain support for the better development of this idea.
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