Searching for That EMR Sweet Spot
At the time the Choosing Wisely® campaign launched in 2012, Utah-based Intermountain Healthcare had already formed a team of 10 clinical programs to improve quality and reduce waste, and was establishing a committee to lead this effort.
Recognizing the goals of the campaign aligned with this work already in progress, Intermountain developed reports to detail how often its 1,500 physicians in eight regions prescribe interventions mentioned in the Choosing Wisely recommendations, including antibiotics and Pap tests. The reports compare clinician ordering to their peers at their site, their region and the system. The medical director and nursing director for each region gather each month to discuss progress, which unifies efforts across the system.
Wayne Cannon, MD, Intermountain’s primary care clinical program leader, said that the primary care group used the report data to assess its utilization rates and identified areas where the group was not in line with the Choosing Wisely recommendations. They then developed an approach to improve in those areas, such as antibiotic prescribing, imaging, labs for preventive care visits and cervical cancer screening.
To advance efforts to change clinician ordering, Intermountain built 23 alerts around Choosing Wisely recommendations into its electronic medical records (EMR) this spring. Thus, if a clinician places a new order that does not meet guidelines around appropriate care, they receive a prompt with an option to order something else.
“We’ve created a detailed report on all the EMR measures to see how often the alerts are activated if ordering is in line with our goals for more evidence-based care,” Dr. Cannon said. “After about a month of using the EMR alerts, it’s still too early to determine the impact on ordering yet.”
One challenge is to avoid overloading the EMR with alerts – or physicians with data.
“We’ve been always refining the approach,” Dr. Cannon added. “With the advice of physicians, we altered the appearance of the report so it is easy for them to interpret. We try to talk to everyone about it to make sure the reports are useful and to reiterate the guidelines.”
While the EMR alerts work to promote conversations between clinicians, Intermountain also refers to Choosing Wisely resources frequently.
“What we built in our EMR is robust, but there can be obstacles to implementation,” Dr. Cannon said. “The national reach of Choosing Wisely is a huge support. We look to others involved with the campaign who are doing similar work to learn all we can.”