- Reducing low-value EHR notifications cut EHR use for primary care providers at VA healthcare facilities by 1.5 hours per week, according to a recent study.
Researchers affiliated with TNT Health Enterprises, VA Sunshine Network, VA Heartland Network, and other VA organizations set out to reduce EHR-related information overload by cutting down on the number of EHR notifications primary care providers receive by inbox. While EHR notifications were initially designed to alert providers of important clinical information, 70 percent of primary care providers now perceive these notifications as excessive.
As part of the study, Shah et al. accessed daily EHR notifications for primary care providers at all 148 VA care sites. Then, researchers standardized and restricted mandatory EHR notification types at all facilities to include only those specified by a recommended list. Finally, the team trained VA primary care providers on how to customize and process EHR notifications more effectively.
“Designated leaders at each of VA’s 18 regional networks led programme implementation using a nationally developed toolkit,” wrote researchers in the BMJ Quality & Safety report. “Each network supervised technical requirements and data collection, ensuring consistency.”
Researchers coached participating providers on how to resolve challenges and monitor the effects of mandatory notifications. To measure the impact of this quality-improvement program aimed at reducing low-value EHR notifications, researchers analyzed notification load before program implementation (March 2017 and after (June-July 2017).
Ultimately, the median number of mandatory EHR notification types at each facility decreased from about 15 to 10. Furthermore, the average number of daily EHR notifications each primary care provider received fell from 128 to 116. Overall, the quality improvement program reduced EHR notifications for VA primary care providers by 9.4 percent.
“Based on prior estimates of 85 seconds to process each notification, this programme potentially saved 1.5 hours per week per PCP, which could be used for higher value work,” suggested researchers. “Programme impact appeared to be achieved by reducing certain types, versus just the sheer number of mandatory notifications, underscoring the complexity of addressing notification burden.”
While primary care providers on average saw a reduction in EHR notifications after implementing the program, some facilities saw an increase in notifications.
Researchers speculated “new types of notifications may have been enabled by PCPs fearing missing important information and could explain why some facilities had higher notifications post-intervention.”
“While pre-implementation pilots at test sites did not support this, subsequent interventions to reduce notifications need to address such potential consequences,” researchers maintained.
Despite encouraging progress in reducing EHR information overload, researchers stated the average number of notifications a primary care provider receives per day is still too high to manage.
“Our findings highlight the feasibility of using large-scale ‘de-implementation’ interventions to reduce unintended safety or efficiency consequences of well-intended electronic communication systems.”
Researchers in a November 2017 JABFM study similarly worked to reduce EHR information overload by showing less data in physician EHR notes.
Ultimately, researchers found showing less data in EHR notes is beneficial to physician productivity and can yield improvements in speed, accuracy, and task load categories. Hiding less relevant data in EHR notes helped to avoid overwhelming physicians with scattered information, improved EHR usability, and reduced clinician burden at participating healthcare organizations.
In addition to hiding less relevant information, researchers also encouraged healthcare organizations to use colored text and bold font to highlight abnormal information in EHR notes. This modification could help to boost clinical efficiency and EHR usability by quickly drawing physicians’ eyes to important or new information.