Prescription for Change

Four keys to enable effective CDS that won't burn out your physicians

by Kelsey Chabal and Sarah Evans

Electronic health records (EHRs) remain a primary driver of physician burnout—and according to Advisory Board's 2018 physician engagement data, EHRs are also one of the engagement drivers for which health systems have the greatest opportunity to improve nationally. And it's no surprise why: The average physician spends 5.9 hours in the EHR per day. (And that doesn't include the 1.4 hours per day they spend on the EHR after work).

Learn 6 underlying strategies to help physician executives drive CDS performance improvement

Not only are physicians spending a disproportionate amount of time in the EHR, but their interactions within the EHR often complicate daily workflows. For example, in a single shift, the average ED physician makes over 4,000 clicks to take the actions he or she needs. Plus, physicians are often inundated with low-value, uninformative alerts—so low-value, in fact, that an estimated 80% to 96% of all alerts are overridden and ignored.

Effectively enabled CDS can improve the physician experience and alleviate burnout

It's no wonder that we often get questions from members who are evaluating clinical decision support (CDS) solutions. CMOs recognize the value of CDS to reduce care variation and improve patient outcomes—but they also recognize the risk of introducing yet another frustration into physicians' EHR experience. We believe that implementing CDS shouldn't contribute to physician burnout—and that, when it's enabled effectively, it can actually be a part of the cure.

When we talk to physicians about what they want from CDS, we most frequently hear the four key features below:

  1. Provide tailored, patient-specific information: Physicians recognize that there's no such thing as "one-size-fits-all" medicine, and effective CDS should, too. Highly intelligent CDS not only reflects the latest in evidence-based medicine, but it tailors guidance to meet the needs of individual patients. It takes into account an individual patient's disease progression and co-morbidities to provide physicians with relevant, tailored, patient-specific information.

  2. Present timely guidance at right point in workflow: CDS guidance is useless if not presented to physicians at the appropriate point in time. Delays in delivering timely guidance can affect the care delivered to patients—and ultimately both quality outcomes and organizational costs. In contrast, CDS presented at the right point in physician workflow can drive appropriate action and ensure patients receive timely, evidence-based care.

  3. Activate high-value alerts only: A constant barrage of pop-ups can drive physicians crazy. When implementing a new CDS system, look for solutions that leverage a range of interruptive and non-interruptive interventions. Ideally, interruptive alerts should be activated only as necessary to alert the physician to harmful activity (e.g. drug-drug interactions) or to escalate past-due and time-sensitive actions.

  4. Offer actionable clinical guidance without interruption: Non-interruptive interventions can be an effective way to provide real-time guidance at the point-of-care without inundating physicians with pop-ups. Look for CDS solutions that leverage alternative means to provide actionable, clinical contextual information in-the-moment, such as a patient-specific summary report that can be embedded in a patient's chart and clearly shows how far along he or she is on a care pathway.
 

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Clinical decision support (CDS) promises fewer medication errors, shorter length of stay, and greater patient safety. However, most organizations struggle with questionable data, alert fatigue, and unintended consequences.

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