VA Program Aimed at Physician Burnout Saves Time by Reducing Electronic Health Record Notifications

A Veterans Administration (VA) program designed to ease physician burnout significantly reduced the number of lower priority alerts delivered to primary care physicians via electronic health record (EHR) notifications, an AHRQ-funded study found. EHR alerts range from high priority alerts, such as abnormal imaging results, to lower priority ones, such as multiple messages from the same lab panel. To minimize low-value notifications that caused physicians to miss critical notifications and contributed to burnout, the VA restricted mandatory notifications to those deemed high priority and trained physicians to customize their inboxes. Results at 148 VA sites showed daily notifications decreased on average from 15 to 10. In addition, 97 percent of physicians received new training on customizing and processing alerts, which allowed for an additional decrease. In all, notifications decreased by an average of 10 percent, which represented a potential 1.5 work hours saved per week. Access the he abstract for the study, published in BMJ Quality & Safety.

2018 Mar 5. pii: bmjqs-2017-007447. doi: 10.1136/bmjqs-2017-007447. [Epub ahead of print]

Impact of a national QI programme on reducing electronic health record notifications to clinicians.

Shah T1, Patel-Teague S2, Kroupa L3, Meyer AND4, Singh H4.

Author information

Abstract

BACKGROUND:

Emerging evidence suggests electronic health record (EHR)-related information overload is a risk to patient safety. In the US Department of Veterans Affairs (VA), EHR-based 'inbox' notifications originally intended for communicating important clinical information are now cited by 70% of primary care practitioners (PCPs) to be of unmanageable volume. We evaluated the impact of a national, multicomponent, quality improvement (QI) programme to reduce low-value EHR notifications.

METHODS:

The programme involved three steps: (1) accessing daily PCP notification load data at all 148 facilities operated nationally by the VA; (2) standardising and restricting mandatory notification types at all facilities to a recommended list; and (3) hands-on training for all PCPs on customising and processing notifications more effectively. Designated leaders at each of VA's 18 regional networks led programme implementation using a nationally developed toolkit. Each network supervised technical requirements and data collection, ensuring consistency. Coaching calls and emails allowed the national team to address implementation challenges and monitor effects. We analysed notification load and mandatory notifications preintervention (March 2017) and immediately postintervention (June-July 2017) to assess programme impact.

RESULTS:

Median number of mandatory notification types at each facility decreased significantly from 15 (IQR: 13-19) to 10 (IQR: 10-11) preintervention to postintervention, respectively (P<0.001). Mean daily notifications per PCP decreased significantly from 128 (SEM=4) to 116 (SEM=4; P<0.001). Heterogeneity in implementation across sites led to differences in observed programme impact, including potentially beneficial carryover effects.

CONCLUSIONS:

Based on prior estimates on time to process notifications, a national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them. Nevertheless, our project suggests feasibility of using large-scale 'de-implementation' interventions to reduce unintended safety or efficiency consequences of well-intended electronic communication systems.