Quality improvement program reduces EHR alerts, saves clinicians 1.5 hours a week

A quality improvement program designed to reduce low-value electronic health record (EHR) notifications led to a 1.5-hour reduction in work for primary care physicians, according to a study published in BMJ Quality & Safety.

EHR notifications, meant to remind clinicians of important patient information, can be an overwhelming burden for physicians. In this study, researchers evaluated the feasibility of a quality improvement program to reduce low-value EHR notifications in the U.S. Department of Veterans Affairs (VA).


“Inefficiencies from EHR use have led to burnout and dissatisfaction among clinicians,” wrote first author Tina Shah and colleagues. “In the Department of Veterans Affairs, EHR-based ‘inbox’ notifications originally intended for communicating important clinical information are now cited by 70 percent of primary care practitioners to be of unmanageable volume. Alarmingly, 30 percent of primacy care practitioners also report missing abnormal test results due to information overload from notifications.”

The quality improvement program included three steps:

  1. Accessing the number of daily clinician notifications 148 VA facilities.
  2. Standardizing and restricting notification types to a recommended list.
  3. Providing clinician training on customization and notifications.

Leaders placed at each of the 18 VA regional networks were charged with leading the implementation of the program, as well as supervision technical requirements and data collection. Pre-intervention data from March 2017 was then compared to post-intervention data from June-July 2017.

Results showed the average number of mandatory notification types decreased from 15 to 10. Average daily notifications per clinician dropped from 128 to 116. Overall, the quality improvement program was able to save about 1.5 hours per week per clinician.

“In conclusion, we found that a national, multicomponent, quality improvement program involving standardization, measurement and training successfully reduced EHR notifications to primary care practitioners by nearly 10 percent,” concluded Shah and colleagues. “This program potentially saved 1.5 hours per week per PCP, which could enable them to spend on higher value work. Our findings highlight the feasibility of using large-scale ‘de-implementation’ interventions to reduce unintended safety or efficiency consequences of well-intended electronic communication systems.”