Doctors’ health is the health system’s top priority. The influx of generalized clinical alerts in the EHR, especially drug-related alerts and internal alerts, exacerbates physicians’ stress.
During its EHR migration, Florida-based NCH Healthcare System optimized medication alerts that are often dismissed by physicians due to a patient’s clinical condition by harnessing patient data Specifically, including test results and comorbidities. This results in targeted alerts for more high-risk patients rather than a blanket alert for many patients.
This case demonstrates the value of proactively minimizing the impact of alert fatigue on physicians and working closely with the pharmacy team when evaluating medication alerts. Health systems found that they could gradually achieve their goals with limited resources and in significantly less time by leveraging existing systems rather than building from scratch, enhancing Doctor’s health and patient safety.
David Linz, director of medical informatics at NCH Healthcare System, will offer insight into this technological achievement at HIMSS24 in a training session titled “Introducing More Meaningful Medication Guides While Addressing Alarm Overload”. We interviewed him to preview his talk.
Ask. What is the overarching focus of your session? Why is this focus important for health IT leaders in hospitals and health systems today?
ONE. Optimizing clinical decision support guidance to address alert fatigue and its impact on clinician well-being is not only important for reducing the negative impact on healthcare professionals. healthcare and improve their efficiency and overall health but is also important for minimizing the financial burden on healthcare organizations and improving the well-being of patients. result.
The influx of generalized clinical alerts in the EHR, especially drug-related alerts and internally developed alerts, exacerbates physicians’ stress. Alarm burden and alarm fatigue are not just caused by high alarm volume; A lack of relevance and actionability for individual patients in specific clinical settings also contributes. While alerts are important for patient safety, their number and lack of patient-specific context contribute to physician burnout.
Excessive warning may ultimately harm patient care by increasing the likelihood of avoidable adverse events. Warnings lacking clear and actionable information also pose challenges. Generic drug warnings are often overlooked, and persistent inaccuracies due to insufficient patient specificity can lead to inappropriate overrides by providers.
In fast-paced clinical environments, alerts that do not accurately identify patient risk and provide next action steps at the right time in the physician’s workflow can increase the burden awareness and frustration, further limiting the provider’s ability to effectively use the alert’s message. To improve drug warning acceptance, incorporating patient-specific factors such as laboratory values, age, and comorbidities consistently has been found to be beneficial.
Q. What is the main learning content you want session attendees to absorb? And how important is this learning to today’s healthcare and/or health IT field?
ONE. By taking a proactive, multidisciplinary approach led by a team of pharmacists, health systems can provide more meaningful drug alerts while addressing alert overload and alert fatigue. tired.
Achieving this requires leveraging patient-specific data, including test results and comorbidities, to deliver more targeted warnings to patients, clearly related to risk. of the patient and applicable to the clinician. The average hospital spends 60 hours per month on ongoing maintenance for custom equipment. clinical decision support.
That estimate includes only reactive adjustments, such as whether a clinician reported a problem with the alert or a patient safety issue was identified. Proactively maintaining alert content to leverage patient-specific information to make it more meaningful and actionable can potentially double that time commitment, if not more than.
Building and maintaining custom drug CDS alerts in the EHR was too time-consuming for our internal IT staff, especially with the EHR system conversion tasks and tasks we performed. currently in 2022.
Our health system found that it could gradually achieve its goals with limited resources and in significantly less time by leveraging existing systems rather than building from scratch, enhancing physician health and patient safety.
We discovered that not only could we reduce the alert burden on physicians, but we could also add critical alerts to further impact patient safety. We saw a 16.6% to 37.5% reduction in the number of optimized alerts per week while adding more meaningful guidance for clinicians.
Another benefit to our system by offloading drug alert management is that it reduces the need for us to find and add pharmaceutical analysts to our staff with experience in CDS functionality in our EHR system and medication value set.
Additionally, because alert content is continuously checked and updated by our vendor partners, our systems do not need to worry about whether the information within is timely or relevant, which is This saves us time and helps protect patient safety, while reducing the risk of physician frustration. triggered by an unrelated, intrusive CDS alert.
The entire solution implementation process of four new targeted drug CDS alerts, including integration with our EHR system from the largest commercial vendor in the market, took just one hour per weeks for 12 weeks. Additionally, each hour-long meeting was productive because we collaboratively built real-time custom alerts throughout the session, saving our IT staff significant time.
Ask. What is another important lesson you want session attendees to take away? And how important is this learning to today’s healthcare and/or health IT field?
ONE. Implementing a CDS optimization system is helpful but requires ongoing review and adjustment to address alert fatigue. A decision support committee was established to comprehensively review the drug warning data and provide mitigation recommendations.
Data reviewed continuously includes number of alerts, override percentage, who alerts are sent to, and feedback from clinicians. The committee includes pharmacists, pharmacy analysts, physicians, nurses, clinical compliance managers, risk managers and subject matter experts from our vendors.
The cadence of meetings is bi-monthly with ad hoc working groups in between. Alerts can trend to show improvement or regression compared to peers and are broken down by category.
Sorting alerts by category, such as duplicate alerts and analgesics by subcategory, helped us identify a significant number of clinically irrelevant alerts that physicians Clinically gave negative feedback. By changing the duplicate allowance from 0 to 1, we can reduce warnings by 25% per order.
We plan to further analyze our opportunities to change overlapping levels and subcategories. We anticipate this will improve provider satisfaction with alert quality and increase attention to follow-up alerts. Combining subjective feedback with objective quantification of alerts and subsequent improvement will help to continuously improve the CDS environment.
The session “Introducing More Meaningful Medication Guides While Addressing Alarm Overload” is scheduled for March 12, 1:30-2:30 p.m. in room W311A at HIMSS24 in Orlando. Learn more and register.
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