A hospital program aimed at reducing EHR alert fatigue by cutting down the number of “interruptive” alerts has made a meaningful impact on the number of alerts clinicians received.
The program was kicked off in 2020, by the Vanderbilt University Medical Center’s Clinical Informatics Center in collaboration with VUMC’s health IT department. The program was designed to optimize clinical decision support alerts generated by eStar, VUMC’s IT system. With clinical decision support alerts being known as best practice advisories or BPAs, the effort to rid the system of suboptimal alerts was named BPA Clickbusters.
The VUMC team went through two three-month rounds of clickbusting in 2020. When the team performed comprehensive reviews of 20% of the rule-based alerts in use, it led to 71,227 fewer interruptive alerts being sent per week. This netted out to a 15% reduction in interruptive alerts overall.
This was definitely a labor-intensive effort. Clickbusters team members, who included physicians, nurses and pharmacists, signed up to review a given BPA in detail and potentially discontinue or improve it.
The participants followed a 10-step process in evaluating the BPA, which began by looking at the clinical logic that prompted its creation and how often users disregarded it. Often, the next step in the process would be to test, place into production and evaluate a new and improved BPA.
Before any recommended changes were made, they were reviewed by the program sponsors or forwarded to relevant clinical governance committees. To keep participants engaged, the sponsors gamified the process by allowing volunteers to score points and win prizes based on the impact the volunteers’ efforts had on the system.
All told, 84 BPAs were reviewed. Of that number, 10 were turned off, 42 were modified and 32 were left in place as is, according to a writeup of the results appearing in the Journal of the American Medical Informatics Association.
According to the researchers who wrote an account of this effort for the journal, this model could prove to be useful in optimizing many other aspects of the EHR. “[Clickbusters] could be readily replicated at other clinical sites and applied to other functions of the EHR, such as order sets, clinical documentation tools, and information displays,” the article noted.
It’s good to hear about a comprehensive program designed to address clinical decision support which doesn’t involve pushing new alerts down physicians’ throats. I’ve never worked in medicine, but I feel their pain where CDS alerts are concerned.
If I had to deal with a pop-up asking me “Are you sure Epic isn’t based in Singapore?” every time I cited the company’s hometown or bugged me about my use of the Oxford comma, I think that I’d end up throwing something at my screen and walking away.
Of course, I have this story in my hands but not someone’s life. I can understand hospitals’ desire to offer important reminders and hopefully not be too intrusive in doing so.
That being said, I seldom read about efforts designed to thoughtfully prune back overgrown CDS alerts that don’t serve clinicians. I’d like to think that other healthcare organizations are going through such exercises regularly but my instinct is that they don’t.
