Interoperable systems and health information exchanges, Diamond and Martich agree, are key first steps to making the systems smarter.
And until the systems are smarter, physicians will resist using them. EMR systems simply don’t have the same information that doctors have about their patients. It’s particularly annoying when systems interrupt doctors’ workflow to alert them to something they already know. And that’s when doctors start clicking through alerts without really paying attention to them. They’re suffering from what’s known as alert fatigue—and it can have serious consequences.
When Diamond first organized CPOE at his community hospital, he says the expectation was that pop-up EBM alerts would improve clinical practice. But the organization soon turned off all of the alerts.
“The rules themselves were becoming dangerous. The systems were not smart enough. And they didn’t have access to other data sources,” he explains.
One solution is to embed EBM into existing order sets. If a physician is already using the set to treat a patient with pneumonia, for example, it is a simple matter to present physicians with a button to click and order the preferred antibiotic.
By offering shortcuts such as this, you “sort of trick physicians” into practicing evidence-based medicine, Diamond says.
Embedding EBM information into data lists—such as a list of quality measures for a certain condition—is another way to sneak EBM into doctors’ normal workflow. It allows the doctor to choose the right option—rather than the computer forcing him or her to do it. A small distinction, perhaps, but physicians respond better to passive checklist-style EMB that’s a part of the normal clinical review, says Diamond.
Organizations can also use diagnostic aids that mesh with physicians’ personalities by suggesting possible diagnoses instead of telling physicians what to do, says James Wolf, an associate professor of information systems at Illinois State University’s School of Information Technology.
In one system, the physician enters symptoms and the program returns a list of possible diagnoses from which physicians can choose. “This allows physicians to engage in research and discover the correct diagnosis—instead of just pressing buttons like an elevator operator,” Wolf says.
“Bridging technology and psychology is how we get people to change behavior,” Diamond says.