When you buy an EMR off the shelf, it usually comes with a standard set of alerts—a drug database that flags possible adverse drug interactions, for example. And the alerts come in varying threat levels—a green, yellow, red system is typical. But vendors and doctors don’t always have the same idea about those threat levels. At UPMC, even the red alerts—the hard stops that interrupt the ordering process—got to be too much. “We fully experienced alert fatigue here,” Martich says.
UPMC employed strategies to overcome these issues. To start, it cut down on the number of alerts that doctors receive—including the red alerts. Healthcare leaders shouldn’t just accept vendor-provided order sets, rules, alerts, and medication databases, Martich says. Customization is key to reducing alert fatigue.
“We actually stopped all of [the alerts] and looked critically at every one of those medication interactions, every one of those that really cause harm,” he says.
Now a multidisciplinary committee reviews and approves all alerts. The inpatient EMR has about 200 alerts, and there are even fewer in the ambulatory system. All are specific to articles and evidence that the organization has developed or incorporated on its own.
To alleviate some of the burden, physicians can bypass alerts, sending them instead to a nurse or pharmacist to evaluate. Pharmacists are authorized to do therapeutic interchanges on their own, for example.
Customization and empowering nonphysicians to implement best practices based on evidence decreased the number of red alerts tenfold—to one out of every 200. Even better, clinicians pay more attention to alerts when they receive a more manageable number.
Creating a robust and customized electronic database isn’t quick or easy, but the rewards will come in time.
“Now that we’ve been up on our inpatient side in some of our hospitals over a decade and our ambulatory side likewise, we have great data-mining capabilities,” Martich says. “[Once] you have a full electronic database, potentially you can do the analytics to re-create or perhaps even debunk some of the evidence.”
That’s “the really fun part,” he says. And, he adds, it can be both life- and therapy-changing.