Eyeworld

September 2017 • Ophthalmology Business 9 them, instead of broadcasting to ev- eryone, as can often happen in large, multispecialty hospitals systems. "Imagine when a 'Code Blue' is called as an overhead page. All the physicians and nurses rush to respond. Patients get rattled. The overhead announcement is vague, disruptive, and unnecessary because not every physician and nurse needs to answer the code," said Ranya Habash, MD, Bascom Palmer Eye Institute, Miami, and co-founder of HipaaChat, which was acquired by Everbridge and integrated into the CareConverge platform. "Every time they leave for a code, their workflow is disrupted, as is their patient care. I see this happen several times a day with my residents. "Instead, when a code is acti- vated, Everbridge routes the mes- sage only to the people who need to respond: the critical care team caring for that specific patient. There is no overhead page, just a special text alert to specific people, which includes the patient's information and clinical situation so the doctors/ nurses actually know what they're getting into," Dr. Habash said. "This is a much better solution for every- one involved." Dr. Areaux said software engi- neering and IT and clinical engage- ment on the issue of alert fatigue is already improving, but "it's not a simple problem" and "we're not there yet." "This is the most pervasive and common medical tool that we all use now," Dr. Areaux said of electronic health record systems. "We all have a responsibility to be engaged in its maturation so we can take better care of patients." OB References 1. Isaac T, et al. Overrides of medication alerts in ambulatory care. Arch Intern Med. 2009;169:305–11. 2. Ancker JS, et al. Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Med Inform Decis Mak. 2017;17:36. 3. Topaz M, et al. Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience. J Am Med Inform Assoc. 2016;23:601–8. 4. Kowalczyk L. Patient alarms often unheard, unheeded. The Boston Globe. February 13, 2011. archive.boston.com/lifestyle/health/ articles/2011/02/13/patient_alarms_often_ unheard_unheeded. Accessed June 28, 2017. 5.Wachter B. The overdose. Backchannel. March 30, 2015. medium.com/backchannel/ how-technology-led-a-hospital-to-give-a- patient-38-times-his-dosage-ded7b3688558. Accessed June 27, 2017. 6. Schreiber R, et al. Think time: A novel ap- proach to analysis of clinicians' behavior after reduction of drug-drug interaction alerts. Int J Med Inform. 2017;97:59–67. Editors' note: Dr. Boland has financial interests with Alcon (Fort Worth, Texas). Dr. Habash has financial interests with Everbridge. Drs. Areaux and Rao have no financial interests related to their comments. Contact information Areaux: areaux@umn.edu Boland: boland@jhu.edu Habash: ranya@hipaachat.com Rao: Naveen.K.Rao@Lahey.org Boland said, adding that the driv- ing force for alerts will primarily be patient safety. "If it's something really unsafe, if there's an allergy to a particular med- ication and they shouldn't receive it, that's an important warning to pop up. If, on the other hand, it's 'This medication is sometimes known to interact with this medication,' there's a bit of gray area. We consider a combination of 'Is it important?' and 'What is the severity of the kind of thing we are trying to prevent?— you're trying to think about those two things carefully," Dr. Boland said. Before turning on a new alert, Dr. Boland suggested piloting it to a small group for feedback before rolling it out to the whole practice or institution. It's also important for physicians to communicate with their vendor or IT department when an alert is not working for them. "The real solution is not asking users to carefully read them all and respond appropriately, it's working with your vendor or IT staff and say- ing, 'These alerts don't help us. Can we please get them turned off?'" Dr. Boland said. Research has shown that reduc- ing alerts can be helpful. A study published in 2017 evaluated the reduction of drug interaction alerts, finding that "targeted DDI alert re- ductions reduce alert burden overall, and increase net efficiency as mea- sured by think time for all prescribers better than for non-prescribers." 6 In addition to reforming the decision support system as a whole, there is software that aims to reduce alert fatigue. CareConverge (Everbridge, Boston), a critical communications software platform, routes alerts and messages only to those who need

• Blank Page
• Blank Page (1)