EHR Alerts Help Improve Care Quality

An EHR system that alerts physicians to potential problems can help enhance performance and improve the quality of care, according to findings from a new study.

An EHR system that alerts physicians to potential problems can help enhance performance and improve the quality of care, according to findings from a study published in Medical Care.

Researchers from Northwestern University Feinberg School of Medicine implemented a multifaceted quality improvement intervention using EHR tools to improve quality measurement, make point-of-care reminders more accurate, and provide more valid and responsive clinician feedback—including lists of patients not receiving essential medications—for 16 chronic disease and preventive service measures.

EHR systems, they hypothesized, “have the potential to revolutionize quality improvement (QI) methods by enhancing quality measurement and integrating multiple proven QI strategies.”

To create the alert system, they integrated existing EHR tools with physician performance reports. The system included a yellow light on the side of a physician's computer that alerted them to possible problems with a patient's care. Physicians could click on the light to learn more about the potential problem.

Additionally, physicians' interactions with the alerts were linked to quarterly performance reports based on quality measures for chronic disease management and preventive care.

In the study, investigators followed 40 primary care physicians at Northwestern Medicine in Chicago, a large internal medicine practice, who implemented the EHR alert system. After one year of using the system, researchers found that:

  • The percentage of heart disease patients receiving cholesterol-lowering medications rose from 87% to 93%;
  • The percentage of patients receiving pneumonia vaccinations increased from 80% to 90%; and
  • The percentage of patients receiving colon cancer screenings increased from 57% to 62%

Performance improved significantly for eight measures during the year before the intervention, compared with 14 measures during the year after the intervention. According to the study, improvements resulted from increases in patients receiving the service, documentation of exceptions, or a combination of both. For five drug-prescribing measures, more than half of physicians achieved 100% performance.

“Implementation of a multifaceted QI intervention using EHR tools to improve quality measurement and the accuracy and timeliness of clinician feedback improved performance and/or accelerated the rate of improvement for multiple measures simultaneously,” they concluded.

"The gains are modest, but if you are already at 90 percent and go to 94 percent, that's important," said lead author Stephen Persell, MD, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital, in an online report.

"It helps us find needles in the haystack and focus on patients who really have outstanding needs that may have slipped between the cracks," said Persell.

To access the study, click here.