By Banner Health is one of the largest health networks in the country, serving more than 8 million patients across the Southwest. With the pandemic sweeping the country, the company started looking for ways to reduce the risk of burnout among staff and providers. The network discovered that one of the main problems was that providers were seeing too many alerts and onscreen pop-up notifications when using electronic health records.
As a provider, you’re probably used to seeing messages and new windows appear as you’re entering information on the screen. Alerts have become a common feature of electronic health records. They’re used to warn providers of potential inaccuracies or medication problems that could put patients at risk.
However, studies show excess alerts can decrease productivity, increase stress, and reduce well-being. So, Banner Health decided to do something about it.
Cultivating Happiness in Medicine
As the pandemic first set in, Banner Health began analyzing burnout and how it could be prevented in the workplace. The company launched CHIM, or Cultivating Happiness in Medicine, a campaign that addresses burnout and improves well-being from various perspectives, including operational, leadership, organizational, individual wellness, community, and second-victim perspectives.
Before implementing the CHIM project, clinicians would receive around 79 alerts per 100 orders for medication. Primary care providers would receive around 6.2 alerts per day, while pharmacists were getting 128.5 alerts per day. These alerts came with a 90% override rate, so clearly providers were getting more alerts than they needed.
Denise Erickson, PharmD, senior director, clinical pharmacy services at Banner Health, commented on the project, “Excessive alerting leads to alert fatigue, which ultimately desensitizes clinicians and decreases the utility of alerts.”
Changing the alert system in an EHR system isn’t easy. Banner Health couldn’t just disable certain alerts without putting patients at risk. It’s important to remember these alerts are meant to save lives and reduce clinical errors. They are often related to medication allergies and duplicate medications.
Erikson said, “Similar to other organizations, we’ve used several strategies, with varying degrees of success, to reduce nuisance alerts and minimize the effects of alert fatigue. Targeting drug-drug, drug-allergy and drug-duplicate alerts has historically been a challenge, since it is resource intensive, a manual process that is difficult to sustain, and there have been functional limitations of EHRs.”
What Are “Nuisance Alerts”?
Some alerts may be doing more harm than good in more than one way. For example, Banner Health discovered that pharmacists were receiving far more alerts than other types of providers, even though many of them contained duplicate information.
In another example, if there’s an interaction between medication A and medication B, providers would traditionally see two alerts, one that says medication A interacts with medication B, and another that says medication B interacts with medication A.
To get rid of this problem, researchers started issuing batch alerts, so providers would only have to interact with one main alert instead several at a time. Studies show batch alerts can improve well-being by limiting the amount of information the user receives.
A notification or alert is known as an external trigger, which often leads to an internal response. When you see an alert on the EHR, you may think, “Oh, I must have made a mistake,” or “I almost put this person’s life at risk.” Alerts can lead you to second-guess yourself, which can be exhausting as the day wears on.
“As we reviewed the information and workflow in each clinical area – inpatient, ED, clinic – we decided to adjust alert preferences to ensure the right information is displayed, at the right time, to the right end user,” Erickson said.
The process was painstaking. Researchers often had to go through individual alerts by hand to determine whether they were essential to the situations at hand. Banner eventually used the Cerner EHR platform to streamline the IT process.
As Erikson explained:
“The Cerner solution provided us with 14 new ways to suppress nuisance alerts,” “Some of the filtering scenarios that had the greatest impact include the ability to suppress alerts within a specific order set, filtering alerts based on order details, and filtering alerts based on the venue of care. For example, our PACU order set by design avoids duplication in therapy. However, it was generating many duplicate alerts due to limitations in how drug-duplicate alerts have historically functioned.”
In the end, Banner Health was able to get rid of 500,000 alerts over the course of a month, which was sustained over a year with a decrease of over 6.2 million alerts.
Erikson has some advice for other health networks looking to reduce the number of nuisance alerts. She says it’s about focusing on the problem you want to solve. Instead of just trying to get rid of alerts, she recommends focusing on reducing burnout and increasing provider productivity.
“We have many alerts that have been in place for many years, and it would’ve been very easy for us to look at an abundance of data and determine we didn’t have the time or the resources to work on such a large project,” she concluded. But with small, incremental improvements, their work paid off.
Banner Health providers can now go about their work without having to sort through dozens of unnecessary notifications.
