- EHR alerts can be helpful for reducing unnecessary use of cardiac monitoring — or telemetry — and cutting excess hospital spending, according to new research published in JAMA Internal Medicine.
Researchers at the Division of Hospital Medicine at the University of California, San Francisco (UCSF) Medical Center conducted a randomized clinical study of 1,066 hospitalizations from November 2016 to May 2017. The trial included physicians on 12 inpatient medical teams.
As part of the study, care teams on a general medicine service of the hospital received an EHR alert integrated into the hospital’s Epic EHR system when a patient’s telemetry order exceeded the recommended length of time.
“The EHR alert was randomized to half of the teams on the general medicine service,” wrote researchers. “The alert displayed during daytime hours when physicians attempted to place an order for patients not in the intensive care unit whose telemetry order duration exceeded the recommended duration for a given indication.”
Ultimately, clinicians received 200 clinical decision support alerts. In response to the EHR alerts, 62 percent of physicians discontinued the current telemetry order. Twenty-one percent of the time, physicians reordered telemetry in response to the alerts, and seven percent of the time they dismissed the EHR alert without taking action.
In 11 percent of cases, physicians acknowledged the alert but opted to continue their current telemetry orders.
Ultimately, researchers found targeted EHR alerts can safely and successfully reduce cardiac monitoring by encouraging physicians to discontinue monitoring when appropriate. Additionally, using EHR alerts to discontinue monitoring have the potential to save hospitals time and money.
“This single-component electronic intervention is less resource intensive than typical multicomponent interventions that include human resources,” noted researchers.
Researchers emphasized that using EHR alerts with the right clinicians, at the right time, within the right clinical context cab ensure the alert is successful.
“Second, we demonstrated this in a randomized trial that minimized the effects of secular trends or unmeasured confounders,” researchers wrote. “Finally, we were able to demonstrate that when physicians were shown these targeted alerts, their majority behavior was to act in a practice standard –concordant way.”
When EHR alerts are used within the right context and with the right care team, the alerts can be effective without requiring educational sessions, audits, or feedback campaigns.
“This study demonstrates a safe reduction in unnecessary cardiac monitoring using a simple, targeted EHR intervention without the need for intensive human resources or non-enduring educational campaigns,” researchers concluded.
While EHR alerts can be useful when applied in a targeted way, low-value EHR alerts can lead to alarm fatigue and information overload.
In a 2018 study, researchers reduced low-value EHR notifications and cut EHR use for primary care providers at VA healthcare facilities by 1.5 hours per week.
The team accessed daily EHR notifications for primary care providers at 148 VA care sites. Then, the team standardized and restricted mandatory EHR notification types at all facilities to include only those specific by a recommended list.
The team also trained VA care providers on how to customize and process EHR notifications effectively.
Overall, providers reduced the median number of mandatory EHR notification types at each facility from about 15 to 10. Additionally, the average number of daily EHR notifications each primary care provider received dropped from 128 to 116. These reductions cut EHR alerts for VA primary care providers by 9.4 percent.
While researchers were able to reduce EHR information overload by cutting down on low-value EHR alerts, the team emphasized that the number of notifications providers receive per day is still too high to manage.