Optimizing the EHR — Alerts and Reminders

Feeling overwhelmed by the volume of patient information that you receive daily and are required to interpret, absorb, and categorize? We hear regularly from users of EHRs that there are benefits and challenges even with the most useful features and functions. Through feedback collected via the EHR user satisfaction survey, clinicians provided the following regarding the use of alerts and reminders:

  • We are a very large corporation using our EHR for both in and outpatient care. The reminders for preventative care are wonderful, but again takes continuous updating to keep it current. Ability to remind self in future of tests, patient needs is good.
  • It takes more time to answer all the reminders and complete the notes. I think number of patients seen overall would go down.
  •  All functions of the software have a learning curve and there are still functions of my system at 7 years that I have not learned how to use. As a non-primary care provider I do not use lots of reminder functions.
  • Our [EHR] version does not allow for easy customization or for reminders or reports for health quality parameters. Reports can be done by our IT dept but in a cumbersome fashion.

Reminders are a type of alert triggered by a parameter such as time and date, high/low threshold, or clinical indication such as the need for an immunization. They are usually presented as color coded or bolded text, or a pop-up that requires action. Reminders serve to cue clinicians that certain events should take place, but have not yet done so. Reminders are regularly used in primary care systems, particularly with respect to the management of patients with chronic conditions that require regularly scheduled repetitive tasks.

When correctly configured, reminders are a useful clinical decision support tool for clinicians as they remove the guesswork out of monitoring and increase confidence that comprehensive care is being provided. However, as noted in the user comments above, they do take more time, particularly if acknowledgments are required before proceeding. In addition, reminders may not be applicable to all care providers. A useful reminder for a primary care physician can be irrelevant for a surgeon. Therefore, if EHRs are not optimized for different roles and settings (particularly in multi-disciplinary clinics in which different specialties work together), reminders can contribute to alert fatigue and become a barrier to care. As part of the optimization process, the inability to adapt reminders to specific clinician needs can also be a challenge. For example, a standard practice protocol may initiate a four-week recall reminder for a specific task; however, the clinician may wish to modify the reminder to a three-week recall time frame. If this type of configuration change is not easily made at the individual clinician level, or requires help from the IT department, it will be too cumbersome to manage and will create frustration for clinicians who have to use “imperfect” processes.

Good data quality is necessary if the system is going to work effectively. If data is not updated and maintained on a regular basis (e.g. administration of immunizations by other care providers recorded in the EHR ) or changes in medications negate previously ordered laboratory monitoring tests, the overall reliability of the reminder system will be brought into question.

How do you use alerts and reminders in your EHR? Are there any best practices you are able to share?


2 responses to "Optimizing the EHR — Alerts and Reminders"
  • February 14, 2013
    Lyle Berkowitz

    I’d suggest a different paradigm, which I call “Team-based Clinical Decision Support”, in which rules/alerts are used to safely and efficiently delegate certain workflow items away from the doctor and towards their team (eg RN or MA). This is for the type of “assembly line” work which is amenable to rules. For example, I helped build some software (called RefillWizard) which intercepts a Renewal request in the EMR, runs it thru the appropriate protocol (based on drug type – it looks at visit dates, labs, vitals, etc..) and then lets staff know if they can renew it without even bothering the doctor (or if there are issues- will be sent to the doctor).

    The result is improved quality and documentation, patient satisfaction due to faster turn-around time, and of course DOCTOR HAPPINESS as they have about 30 minutes less work to do every day!

  • February 16, 2013
    Prasad K. Patankar

    Alerts can be used to draw attention to protocols. For example, a nurse manager on a floor can be alerted if any patients have a medication due so she/he can follow up with the doctor. This way, these alerts can be sent to clinicians with responsibility for achieving compliance.

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