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NCH Healthcare System reduces drug alerts, and stress on clinicians


The Florida health system uses technology to send doctors more targeted medication alerts. David Linz of NCH talks about the effort.

Physicians regularly get alerts from electronic health record systems when patients are given new medications, advising them of how they can interact with other prescriptions.

Doctors get a lot of alerts.

For many doctors, the number of medication alerts can get overwhelming, and add to their stress, says David Linz, chief medical informatics officer at NCH Healthcare Systems. Linz also says that many of those alerts are unnecessary.

The Florida-based health system has worked to develop more targeted medication alerts. Linz talked about NCH’s refined medication alerts at the HIMSS Global Health Conference & Exhibition earlier this month.

“It's about making the alerts more meaningful to the right person at the right time, and make them actionable. And not only that, but to try to make them less frequent … but more meaningful,” Linz told Chief Healthcare Executive®. (See part of our conversation in this video. The story continues below.)

NCH undertook the initiative to help patients and alleviate some of the burdens on their doctors. Physicians regularly cite administrative burdens as the leading cause of stress and burnout.

“This has really been part of our initiative to improve patient quality and physician satisfaction, reduce burnout,” Linz said. “We've been successful and we're proud of it.”

NCH teamed with FDB (First Databank, Inc.) on the project to send clinicians more targeted medication alerts. Older patients often take a host of prescriptions, and new medications can interact with other drugs in ways that require monitoring.

“The quantity of medication is a challenge, but also it's a double-edged sword, in the sense that we know more about medications now than we've known, probably ever,” he says. “How you use that information effectively is really important.”

FDB has algorithms that offer insights on drug interactions with higher risks for patients, and NCH can adjust alerts based on what clinicians are seeing with patients. If the electronic health record system is generating too many alerts, “we can dial that back,” Linz said.

“Just because something has an interaction doesn't mean that it needs to be alerted to everybody all the time,” he said.

So far, the reduction in medication alerts has been about 25%, and the drop has been higher in some areas, Linz said.

“We know that's not all we can do,” he said. “We've built a team and we're building the skills in how we analyze the data. And now we're looking at how to make those changes. It's a fine line. You know, we don't know what's the right amount of alerts, but we know we're not there yet.”

For physicians, alert overload can be a nagging issue.

“We know that there's a lot of dissatisfaction of getting not only too many alerts, but too many alerts that aren’t patient-specific,” Linz said. “And so that's where we can leverage what we know about drugs, what we know about the patients, to develop those more meaningful alerts.”

The journey began more than three years ago, when NCH wanted to change its electronic health record system. But the system also wanted to use that transition as a “cultural shift” in solving problems, Linz said.

Building the right decision team to tackle the challenge of reducing medication alerts was critically important to its success, he said.

“That's been the collaboration of pharmacists, nurses, physicians, but also members of our quality department are our risk management team, so that we can look at all decisions that we make from different angles and collectively make that decision more quickly,” Linz said.

When asked about the best feedback he’s received, Linz said with a smile, “The best feedback is frequently lack of feedback. Our physicians historically have not been afraid to let us know what's broken.”

Linz said the success in reducing alerts is prompting more meaningful interactions with NCH clinicians, who are sharing other technology challenges they are facing. “We're changing the culture also where they think improvement can happen,” Linz said.

The project to refine medication alerts is one that other health systems could emulate, Linz said. “It's really something that I think others can do,” he said.

The secret sauce to making the project successful has been the use of a multidisciplinary team, which health systems should employ for big tech projects, he said.

“So many aspects of our day-to-day work affect one another, and any one decision that affects one group can affect the other, and so it's important to make those decisions together,” Linz said.

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