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A great deal of debate over whether EHRs actually are improving patient care has occurred over the last few years, and it sometimes seems like the majority are arguing that they do not.
In light of the tremendous time and effort expended by providers, office staff and yes, EHR vendors, the idea that it’s all for naught is very disheartening.
One of the major issues causing dissatisfaction is “alert fatigue,” when clinicians are overwhelmed by the volume of EHR alerts, sometimes to the point of ignoring the alerts. This can lead to disastrous results, as in a case, reported in the June 2013 Pediatrics, of a two-year-old patient whose caregivers disregarded drug allergy alerts, leading to the worsening of his condition.
Fortunately, there is some very good news surfacing about EHRs: Health Maintenance Alerts are beginning to show positive results.
The following case study reflects the potential for EHRs to save patient lives and improve patient care.
Date of Program Initiation: 2010
Objective: Provide real-time clinical support at point of care
Program Description: When designing the health maintenance alerts feature in HealthFusion’s MediTouch, the engineering team strove to alert doctors to preventive care interventions without distracting from patient interaction and immediate care needs. The theory was that if properly executed, health maintenance alerts could serve the desired purpose without unnecessarily detracting from the patient encounter.
Evaluation Process: The evaluation process for the outcome of this design process included several data points:
- User feedback
An unsolicited report from a physician using MediTouch documented a positive result from use of a Health Maintenance Alert, described below under “Results.” On a broader scale, HealthFusion regularly receives feedback from MediTouch users through surveys, email and other communications such as email and phone calls to our Customer Support team. The results support this report from the physician user: The Health Maintenance alerts provide a useful reminder without distracting from patient care.
- Industry Surveys and Ratings
Independent, external surveys have also validated the Health Maintenance Alert feature; Medical Economics recently published a “Best EHRs of 2014” nationwide survey of physicians in which users rated key features of the EHRs they used.
In this independent survey, MediTouch was top-ranked for Clinical Decision Support (CDS) by users. Medical Economics said that “Intuitive clinical decision support—including alerts and reminders, clinical guidelines, documentation templates and focused patient data reports—can help doctors improve care and meet quality measures.”
Results
A MediTouch user, Dr. Kay Barney, found that the Health Maintenance Alert helped her insure that a patient received the care he needed. In fact, the specialist to whom the patient was referred said that this action saved his life.
MediTouch Health Maintenance reminders offer an alert in the form of a red triangular icon, as shown below. Alert fatigue can be an issue with some EHR software when the alerts frequently pop up and interrupt patient care, but in this case the design team has strived to insure that alerts are prominent enough to get a physician’s attention while not causing alert fatigue. In this case, the alert did its job and helped Dr. Barney insure the patient was proactive in scheduling a needed test.
“I had saved my patient’s life”
“I regularly clear the ‘red triangle’, the MediTouch health maintenance marker, because it means that I’ve reminded my patients to get the appropriate preventive tests,” Dr. Barney reported. “The GI specialist I refer to called today and told me that I had saved my patient’s life. He had found a polyp with adenocarcinoma down to the wall of the sigmoid colon.
“I know that I didn’t really save it, my red triangle reminder did,” said Dr. Barney. “Just thought you would want to know about a success story.”
Lessons Learned
After reviewing these results, the conclusions on Health Maintenance Alerts include:
- Clinical decision support, including EHR alerts, can result in improved patient care. A variety of randomized controlled trials, including Hicks, et al1 and Kawamoto2, clearly demonstrate that CDS can improve care. This case study is representative of the type of results that we expect to see across a broader spectrum as EHRs are fully utilized.
- Educating and training clinicians on the use and value of EHR alerts can contribute to better results from clinical decision support. A program at Boone County Health Center involving analysis of alerts and focused training of team members, reported on healthit.gov, has helped reduce alert fatigue and ensure the EHR system is consistently serving as a tool to help providers improve patient care.
- It’s vital for EHR vendors to work with clinicians to eliminate unnecessary alerts, thus avoiding alert fatigue. In the Pediatrics study cited above, the authors noted that staff physicians, pharmacists and informaticists worked with the EHR vendor to modify and improve the allergy alerting system after the incident with the two-year-old patient. This is the type of collaborative effort needed to develop the EHRs of the future, and a very significant part of the process at HealthFusion.
The outcome that Dr. Barney saw is the kind of result we have all been looking for with electronic medical records; the consistent health monitoring that can only be done efficiently with technology, resulting in improving, and even saving, patients’ lives.
As the former National Coordinator for Health IT, Farzad Mostashari, M.D., famously put it: “…the provider can’t go into the room of paper charts and flourish their wand and say ‘All the patients with diabetes!’ and the charts fly out and hover in the air…We can’t do that on paper. But that is the essence of population health management.”
How well your EHR provides real-time feedback about a patient you’re caring for can and will influence the lives of the patient population you’re caring for.
Only the most forward-looking EHR companies can do this now, but it’s vital for the future of healthcare: There’s power in the data.
And healthcare is now beginning to make use of that power in improving patient care.
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Dr. Seth Flam is one of the founders of HealthFusion and serves as the company’s CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR. He can be reached at Update@HealthFusion.com. Image via Wikipedia.
- Hicks LS,Sequist TD, Orav EJ, et al. Impact of computerized decision support on blood pressure management and control: a randomized controlled trial. J Gen Inter Med 2008;23:429–41.
- Kawamoto K,Houlihan CA, Balas EA, et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005;330:765.
