Clinical Decision Support: Say No to Alerts!

One of the most disruptive obstacles in a physician’s workflow has become the proliferation of alerts that pop-up while using electronic health records (EHRs). However, studies have consistently demonstrated that alerts are are overridden by physicians 49-96% of the time.1, 2 These alerts fundamentally fail because rather than saving practices time and money alerts interfere with the clinical workflow of providers.

Many in the health IT field incorrectly view EMR alerts and clinical decision support (CDS) as being interchangeable. However, CDS software has the potential to be much more impactful than just alerts and the two should not be thought of as being synonymous. The latest generation of CDS systems strive to deliver tangible value and improved patient outcomes. They work to accomplish these objectives through integrating seamlessly into the clinical workflow with the goal of delivering meaningful information at the right time targeted to the patient at hand.

Newer CDS solutions are exploring approaches that save practices time and money by delivering value to users outside of the physician-patient encounter. A recent publication in the Journal of the American Medical Informatics Association identified the pre-visit as a key time for CDS systems to help doctors prepare for the day by identifying high risk patients (see Fig. 1)3. In addition, newer CDS systems can help practices follow up on complex patients who fall through the cracks and who do not complete necessary orders, such as laboratory work or radiology exams.

Figure 1: Opportunities for CDS in Primary Care Settings

Based on this exciting new research, it is clear that stakeholders need to reevaluate how best to integrate CDS into their practices’ clinical workflow. More and more, it is becoming evident that CDS solutions have much to offer practices that are serious about saving time and money through streamlining their clinical workflow. As value-based care models like ACO’s and patient-centered medical homes become increasingly common, these new CDS systems have the potential to translate into happier patients, less wasted dollars, and shared savings for providers.

1 Van der Sijs H, et al. *J Am Med Inform Assoc.* 2006;13:138-147.
2 Russ AL, et al. *Int J Med Inform*. 2012 Apr;81(4):232-43.
3 Richardson JE, Ash JS. *J Am Med Inform Assoc*. 2011 Dec; 18(Suppl 1): i28–i35.

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Daniel Wasser, MD

Daniel Wasser, MD, is a General Practitioner and Physician Ambassador for Grand Round Table. He is a firm believer that practices must proactively engage with EHR and clinical decision support to ensure that their unique needs are incorporated into the next generation of EHR technology.