VUMC's 'Clickbusters' program targets EHR fatigue, reduces alerts by 10%

Nashville, Tenn.-based Vanderbilt University Medical Center recently launched a program called 'Clickbusters' to reduce the number of automated alerts and reminders in the EHR, according to a July 16 news release.

VUMC in April teamed up with the Vanderbilt Clinical Informatics Center and the medical center's health IT department to develop the program, which alters when best practice advisories, or automated alerts and reminders, are sent out and for which EHR users.

Clickbusters to date has reduced BPAs by 49,000 per week, or about 10 percent of the 488,000 BPAs typically fired in a week to VUMC users interacting with the Epic EHR. However, the hospital's goal is not to strictly reduce the number of BPAs but rather improve their delivery, according to VCLIC director Adam Wright, PhD.     

"We believe in alerts. There should be a lot of good alerts in the system that are accepted a lot of the time and that people find to be useful," Dr. Wright said. VUMC can audit which BPAs users ignore and which they choose to act upon; currently, the alerts are acted upon about 8 percent of the time, which VUMC hopes to increase to 30 percent through the program.

The hospital launched the second round of Clickbusters on June 29 with a new list of BPAs to investigate. The process includes volunteers such as physicians, nurses and pharmacists who review a given BPA in detail using a 10-step approach, including assessing for clinical logic that prompted the advisory and how often the alert is disregarded in practice.

VCLIC updated the system to now feature emoticons including a smiley face, a sad face and an in-between face to express a user's general level of satisfaction with a BPA. Clicking on one of the emoticons records the user's satisfaction and presents a dialogue box for the user to write optional comments, which is used to improve the system. Epic Systems, VUMC's EHR vendor, noticed the emoticon system and is adding it to their product, according to the report.

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