EBM12: Physicians can only be engaged through actionable data
CHICAGO—Actively engaging physicians to use evidence-based medicine requires providing them with actionable information that is usable in practice, according to Sameer Badlani, MD, CMIO at the University of Chicago, during a Oct. 4 presentation at the CMIO Leadership Summit on Transforming Healthcare through Evidence-Based Medicine.
It takes 50 percent of U.S. physicians 17 years to adopt a published guideline, according to the Agency for Healthcare Research and Quality’s “Closing the Quality Gap Fact Sheet,” explained Badlani. Likewise, the average adherence to published guidelines by U.S. physicians is 50 percent (N Engl J Med 2003;348:2635-2645).
Finally, the average amount of time spent creating a clinical decision support (CDS) rule or an order set is 40 hours. “Providers are spending a lot of money to set these up, and a great deal of knowledge goes into them institutionally, but the CMIO’s role is to establish value,” Badlani added.
For physicians to adopt a technology, they must trust the information disseminated from the technology, he said. Therefore, physicians will question the designer of the technology, such as a reputable online source or trusted colleague.
Therefore, he recommended using a few strategies to persuade physicians to buy into the new therapy, namely:
When considering the transparency and communication of this information, Badlani suggested that health IT executives use the technology to help the end users (physicians) focus on why these folks should care to address quality, safety, cost, as well as Meaningful Use measures.
“Despite the widespread attention Meaningful Use has received, it’s surprising how [many physicians] still haven’t heard of Meaningful Use—even in a large, academic medical center,” he added. “Put yourself in the shoes of a busy practitioner who’s just learning his or her way around an EHR, and now is being required to adhere to a new measure.”
To achieve these ends, he recommended that CMIOs work with quality chairs in clinical domains, not necessarily the informatics expert; align specific measures with specific institutional goals; and reference relevant information within the order set of CDS guidance. Finally, the cost factor should only be part of the discussion—not the only, or leading, reason—because physicians are typically more concerned with clinical quality and patient outcomes.
Finally, Badlani advised the audience to be aware of the information explosion. “CMIOs should know how many alerts are being fired at physicians from their EHRs per day, per physician,” he said. “Audit your system on an annual basis and recognize the problem of alert fatigue to engage physicians on a personal level.“
At University of Chicago, for example, there were 250 order sets established before the deployment of its computerized physician order entry (CPOE) system. However, the provider quickly realized that only 50 of them were being utilized, and only 10 were being used regularly. Now, they assess how often an order set has been used in the last 18 months before deploying it in the CPOE, and consider retiring under-utilized order sets at a bi-monthly meeting.
“We need to make a paradigm shift that is not just for convenience or for standards, but also to establish evidence-based medicine,” Badlani said. “I have challenged my team to show me which order sets are truly actionable, as we have to be careful about alert fatigue.” If not, physicians may begin to ignore order sets.
The difference between an actionable alert and an alert that is simply informative is a focus on usability for sustained engagement. To do this, he suggested that
Finally, Badlani suggested that CMIOs and other health IT executives should “actively work to engage the end user by building trust through information and focusing on usability.” He also encouraged them to praise physicians and end users who get involved in the process because the process is ongoing and needs clinical engagement to continually measure, analyze and adapt.
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.
It takes 50 percent of U.S. physicians 17 years to adopt a published guideline, according to the Agency for Healthcare Research and Quality’s “Closing the Quality Gap Fact Sheet,” explained Badlani. Likewise, the average adherence to published guidelines by U.S. physicians is 50 percent (N Engl J Med 2003;348:2635-2645).
Finally, the average amount of time spent creating a clinical decision support (CDS) rule or an order set is 40 hours. “Providers are spending a lot of money to set these up, and a great deal of knowledge goes into them institutionally, but the CMIO’s role is to establish value,” Badlani added.
For physicians to adopt a technology, they must trust the information disseminated from the technology, he said. Therefore, physicians will question the designer of the technology, such as a reputable online source or trusted colleague.
Therefore, he recommended using a few strategies to persuade physicians to buy into the new therapy, namely:
- Link sources within the order set or CDS to external guideline(s);
- Name the local subject matter expert or taskforce (quality committee, drug safety taskforce) who vetted the information;
- Provide the grade of the quality of information; and
- Make it specialty-specific, as the different specialties have different preferences.
When considering the transparency and communication of this information, Badlani suggested that health IT executives use the technology to help the end users (physicians) focus on why these folks should care to address quality, safety, cost, as well as Meaningful Use measures.
“Despite the widespread attention Meaningful Use has received, it’s surprising how [many physicians] still haven’t heard of Meaningful Use—even in a large, academic medical center,” he added. “Put yourself in the shoes of a busy practitioner who’s just learning his or her way around an EHR, and now is being required to adhere to a new measure.”
To achieve these ends, he recommended that CMIOs work with quality chairs in clinical domains, not necessarily the informatics expert; align specific measures with specific institutional goals; and reference relevant information within the order set of CDS guidance. Finally, the cost factor should only be part of the discussion—not the only, or leading, reason—because physicians are typically more concerned with clinical quality and patient outcomes.
Finally, Badlani advised the audience to be aware of the information explosion. “CMIOs should know how many alerts are being fired at physicians from their EHRs per day, per physician,” he said. “Audit your system on an annual basis and recognize the problem of alert fatigue to engage physicians on a personal level.“
At University of Chicago, for example, there were 250 order sets established before the deployment of its computerized physician order entry (CPOE) system. However, the provider quickly realized that only 50 of them were being utilized, and only 10 were being used regularly. Now, they assess how often an order set has been used in the last 18 months before deploying it in the CPOE, and consider retiring under-utilized order sets at a bi-monthly meeting.
“We need to make a paradigm shift that is not just for convenience or for standards, but also to establish evidence-based medicine,” Badlani said. “I have challenged my team to show me which order sets are truly actionable, as we have to be careful about alert fatigue.” If not, physicians may begin to ignore order sets.
The difference between an actionable alert and an alert that is simply informative is a focus on usability for sustained engagement. To do this, he suggested that
- An alert or order set should always make the right action easy and provide it in the same screen shot.
- There should always be an option for the user to tell you why he/she is declining the advice.
- Don’t assume end users are lazy.
- The actions within a CDS or order set should be measurable to the patient/end user.
- Analyze delays in workflow and meaningfulness of the rule.
- There is nothing such as an perfect alert – be willing to adapt your masterpiece.
Finally, Badlani suggested that CMIOs and other health IT executives should “actively work to engage the end user by building trust through information and focusing on usability.” He also encouraged them to praise physicians and end users who get involved in the process because the process is ongoing and needs clinical engagement to continually measure, analyze and adapt.
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.