How NCH Healthcare reduced the alarm burden with more meaningful CDS
Physician well-being is a top priority for healthcare systems. The influx of generic clinical alerts within EHRs, especially medication-related alerts and built-in alerts, is exacerbating physician stress.
During the EHR transition, Florida-based NCH Healthcare System optimized medication alerts that were often dismissed by physicians due to patients’ clinical status, using specific patient data, including laboratory results and comorbidities. This resulted in targeted alerts for higher risk patients rather than generic alerts for a wide range of patients.
This case demonstrates the value of proactively limiting the impact of alert fatigue on physicians and working closely with the pharmacy team when evaluating medication alerts. The healthcare system discovered that it could achieve its goals incrementally with limited resources and in significantly less time by using a turnkey system rather than building from scratch, improving physician well-being and patient safety.
David Linz, chief medical informatics officer at NCH Healthcare System, takes an in-depth look at this technological achievement HIMSS24 during an educational session titled “Introducing More Meaningful Medication Guidance in Addressing Alert Overload.” We interviewed him to get a taste of his talk.
Q. What is the overarching focus of your session? Why is this focus important for healthcare IT leaders in hospitals and healthcare systems today?
A. Optimizing clinical decision support guidelines to address alertness fatigue and its impact on physician well-being is not only critical for reducing negative impacts on healthcare professionals and improving their overall efficiency and well-being, but is also critical to minimizing the financial burden on healthcare organizations and organizations. improving patient outcomes.
The influx of generic clinical alerts within EHRs, especially medication-related alerts and internally built-in alerts, is exacerbating physician stress. The alarm burden and the resulting alarm fatigue are not only caused by a high alarm volume; lack of relevance and usefulness for individual patients in specific clinical settings also contributes. While alerts are critical to patient safety, the volume and lack of patient-specific context contribute to physician burnout.
Excessive warning can ultimately harm patient care by increasing the likelihood of avoidable side effects. Alerts that do not provide clarity and actionable information also pose challenges. General medication alerts are too often ignored, and continued inaccuracy due to insufficient patient specificity can lead to inappropriate overrides by healthcare providers.
In a rapidly changing clinical environment, alerts that fail to concisely identify patient risks and provide actionable next steps at the right time in the clinician’s workflow can increase cognitive burden and frustration, making it a healthcare provider’s ability to effectively use the warning message is further limited. To improve medication alert acceptance, it has been consistent to integrate patient-specific factors such as laboratory values, age, and comorbidities.
Q. What is the most important learning experience you would like session participants to walk away with? And how is this learning vital to healthcare and/or healthcare IT today?
A. By taking a proactive, multidisciplinary approach, led by the pharmacy team, healthcare systems can produce more meaningful medication alerts while addressing alert overload and alert fatigue.
To achieve this, it is necessary to leverage specific patient data, including laboratory results and comorbidities, to make targeted alerts more patient-specific, clearly associated with patient risks and useful to clinicians. An average hospital spends 60 hours per month on ongoing maintenance on customization clinical decision support.
That estimate only includes reactive adjustments, such as if a physician reported a problem with an alert or if a patient safety issue was identified. Proactively maintaining alert content to leverage patient-specific information to make it more meaningful and actionable would likely double that time commitment, if not more.
Setting up and maintaining custom medication CDS alerts within the EHR was far too time-consuming for our internal IT staff, especially with the tasks and duties of an EHR system switchover, which we performed in 2022.
Our healthcare system discovered that it could achieve its goals incrementally with limited resources and in significantly less time by using a turnkey system instead of building from scratch, improving physician well-being and patient safety .
We found that we could not only reduce the alert burden on our 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 easing the burden of managing medication alerts is that we do not have to find and add to our staff pharmacy analysts who have experience with CDS functionality in our EHR system and medication value sets.
In addition, because the content of alerts is continuously monitored and updated by our vendor partner, our system does not have to worry about whether the information contained within is current or relevant, saving us time, helping to protect patient safety and reducing the risk of physician frustration . caused by an irrelevant, intrusive CDS warning.
The entire solution implementation process of four new targeted medication CDS alerts, including integration with our EHR system from the largest commercial vendor on the market, took just one hour per week for twelve weeks. Additionally, each hour-long meeting was productive because we collectively built our custom alerts in real time during the session, saving our IT staff a lot of time.
Q. What is another key lesson you would like session participants to take away with? And how is this learning vital to healthcare and/or healthcare IT today?
A. Implementing a CDS optimization system is helpful, but continued evaluation and adjustments are necessary to address the problem of alert fatigue. A decision support committee was formed to comprehensively review the medication alert data and make mitigating recommendations.
Data under continuous review includes the number of alerts, override rate, who the alert is sent to, and physician feedback. The committee consists of pharmacists, pharmacy analysts, physicians, nurses, clinical compliance managers, risk managers and subject matter experts from our vendor.
The frequency of the meetings takes place bimonthly, with ad hoc working groups in between. Alerts can be consolidated to show improvement or decline, compared to peer organizations, and broken down by category.
By sorting alerts by category, such as duplicates and subcategories of analgesics, we were able to identify a significant number of non-clinically relevant alerts for which physicians provided negative feedback. By changing our duplicate limit from 0 to 1, we were able to reduce the number of alerts per order by 25%.
We have plans to further analyze our ability to change duplicate reimbursement levels and subcategories. We expect this will improve provider satisfaction with the quality of alerts and increase attention to subsequent alerts. Combining subjective feedback with objective quantification of alerts and subsequent improvement is useful to continuously improve the CDS environment.
The session, “Introducing Meaningful Medication Guidance During Tackling Alert Overload,” is scheduled for March 12, 1:30 PM – 2:30 PM in room W311A at HIMSS24 in Orlando. More information and registration.
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