Reducing unnecessary care has been a core mission at Henry Ford Medical Group in Michigan since 2012. Since becoming a Choosing Wisely grantee partner in 2015, the Henry Ford Physician Network has focused on reducing unwarranted use of antibiotics, diagnostic testing for low back pain and Vitamin D screenings.
To achieve these goals, the health system has activated nearly 30 electronic health record (EHR) alerts to date that help clinicians consider what test and treatments are appropriate at the point of care.
Since clinicians had limited bandwidth to create their own best-practice alerts, Henry Ford turned to Stanson Health, a California-based software developer, for a turnkey solution to provide high-quality alerts in the EPIC EHR environment, said Bruce Muma, MD, FACP, Medical Director for Henry Ford Medical Group Population Health and Chief Medical Officer for the Henry Ford Physician Network.
Stanson has converted most of the Choosing Wisely recommendations into best practice alerts for the EPIC environment and has created additional alerts focused on quality, safety and resource stewardship. The alerts are well designed, and clinicians have the ability to override the alerts if needed.
During the pilot phase, Dr. Muma and colleagues activated seven alerts and ran those for three months to assess the impact and cost benefit. Following that, they turned on about 20 additional alerts.
Through the EHR platform, Dr. Muma and his colleagues can track how often the alerts are triggered and receive quarterly assessments to determine if the alerts led to improved health care quality and safety and any potential cost savings.
“One of the hardest things in population health is to measure the impact of an intervention,” Dr. Muma said. “Though it’s hard to quantify what didn’t happen, we are able to see significant benefits with each wave of alerts we activate.” For example, Henry Ford demonstrated significant reductions in the following areas, which also resulted in cost savings:
- Antibiotic use for bronchitis fell from 77 percent in 2014 to 25 percent in 2017
- Inappropriate Vitamin D testing decreased from 31 percent in 2014 to 2 percent in 2017, and Vitamin D orders per day dropped from 195 in 2014 to 84 in 2017
- Orders for red blood cell counts when hemoglobin count was greater than 7 decreased from 61 percent in 2014 to 42 percent in 2017
The team has also found that alerts are more effective when they are combined with other interventions, including clinician engagement, performance feedback and patient education about why they may not need certain tests and treatments.
Dr. Muma added that Henry Ford also wants to be sensitive to “alert fatigue,” which is a challenge in most EHR systems. He said the Stanson alert methodology is well constructed, and their analytic support enables users to assess the overall alert environment.
“Understanding the impact of an alert on clinical decision making helps us determine when to launch an alert, when to modify an alert and when to discontinue an alert,” he said. “In 2018, this work to activate and refine alerts will continue, and we want to make sure they are synergistic with other value-based care initiatives.”