EHR Integration Boosts Clinical Decision Support, Eases Clinician Burden

EHRs aim to streamline patient care by providing clinicians with up-to-date access to patient health records. Ideally, providers would pull up a patient’s EHR record and have all the information they need in one place. But without key EHR integration with workable clinical decision support, this is not always the case.

EHRs often require providers to take time out of their days to manually click through the system to gather the clinical information they need to care for patients. This burdensome process takes time away from patient care delivery and can lead to clinician burnout.

A clinician-developed EHR integration is helping enhance clinical decision support and reduce clinician burden.

The application’s co-creator, Ajay Dharod, MD, vice chair of informatics and analytics for the Department of Internal Medicine at Wake Forest Baptist Health, said that as a practicing physician, he was burdened by spending up to an hour clicking around the EHR to gather clinical information before beginning his rounds.

Physicians spend on average 16 minutes and 14 seconds per encounter using EHRs, with chart review and documentation functions accounting for most of the time, according to 2020 research published in the Annals of Internal Medicine.

“The amount of data required to make a good clinical decision on an individual patient is enormous, and we should be individualizing our decisions for patients as clinicians,” Dharod noted in an interview with EHRIntelligence.

To cut back on clinician burden, Dharod created the WHIRL app in 2017 alongside former colleague Mark Frankel, MD.  The application automatically pulls together pertinent clinical information for providers for clinical decision support, eliminating the need to manually click through the EHR.

But using clinical decision support can be tricky business. While its use has proven to improve clinical quality outcomes, clinical decision support can be detrimental to the provider.

Clinicians who may already be struggling with EHR overload may experience clinical decision support alert fatigue, exacerbating clinician burden. Additionally, low-value EHR alerts can negatively impact patient care.

Dharod said that he and Frankel wanted the application to provide as much data density as possible without overwhelming clinicians. This required visualizing the data in a clinician-friendly format.

Clinician feedback from beta testing at Wake Forest allowed for Dharod and his co-developer to optimize the software so it was as functional and clinician-friendly as possible, he noted. This required shifts in minute details such as time date stamps and shading.

In early 2020, the developers partnered with Illumicare to re-engineer the application within the health IT vendor’s Smart Ribbon technology. This partnership extends the tool’s benefits from Wake Forest to health systems nationwide, allowing any health system to implement the software through Illumicare.

This system is discreet, Dharod noted, with messages appearing on the side of a physician’s screen rather than stopping physicians in their tracks.

“There are simply suggestions that float in to get you thinking about costs and options, and then float away to let the clinicians do what they do best, which is care for patients, with that nudge of decision support,” Dharod explained.  

Dharod said that time spent using the EHR has gone down and clinician EHR satisfaction has gone up at Wake Forest directly due to the implementation of the software. He added that there has not been an increase in reported adverse events, as well.

“Now, for the most part, more than 90 percent of the information I need every morning when I'm about to go see my 16 to 20 patients on the general medicine wards is pulled together and formatted in a way that's really meaningful in a few clicks,” Dharod explained.

Ultimately, the EHR integration has helped clinical providers save thousands of clicks per day, by eliminating tasks that were preventing physicians from working at the top of their license.

“This has been an incredibly valuable tool for clinical providers at Wake Forest,” Dharod explained. “Several of our residents, fellows, and faculty members say they get to spend an extra 20 to 30 minutes per day focusing on patient care as opposed to digging through the EHR.”

Dharod noted that saved time can be go toward a variety of tasks, such as delivering patient care, teaching medical students, interacting with nursing staff to gather information on a patient, or calling a nursing facility to inquire about medications.

“We're noticing our providers continuing to be burdened with tasks that are not ‘at the top of their license,” Dharod said. “Simply gathering information, spending anywhere from 30 minutes to an hour clicking around an EHR, is ineffectual.

Dhaord explained that after beta testing, the software was organically adopted throughout Wake Forest health system. Now, the software, which integrates with the Epic App Orchard, touches about 80 percent of admitted patients across the network of hospitals.

“This is a software application that providers are voluntarily using,” Dharod added. “It's not a required thing; it's that they want to use it because it helps them and it saves them time. If it helps clinicians throughout the country save time, then I have done my due diligence.”