Clinician collaboration to improve clinical decision support: the Clickbusters initiative

Allison B McCoy; Elise M Russo; Kevin B Johnson; Bobby Addison; Neal Patel; Jonathan P Wanderer; Dara E Mize; Jon G Jackson; Thomas J Reese; SyLinda Littlejohn; Lorraine Patterson; Tina French; Debbie Preston; Audra Rosenbury; Charlie Valdez; Scott D Nelson; Chetan V Aher; Mhd Wael Alrifai; Jennifer Andrews; Cheryl Cobb; Sara N Horst; David P Johnson; Lindsey A Knake; Adam A Lewis; Laura Parks; Sharidan K Parr; Pratik Patel; Barron L Patterson; Christine M Smith; Krystle D Suszter; Robert W Turer; Lyndy J Wilcox; Aileen P Wright; Adam Wright

doi:10.1093/jamia/ocac027

Clinician collaboration to improve clinical decision support: the Clickbusters initiative

J Am Med Inform Assoc. 2022 May 11;29(6):1050-1059. doi: 10.1093/jamia/ocac027.

Authors

Allison B McCoy^{1

2}, Elise M Russo¹, Kevin B Johnson^{1

2

3}, Bobby Addison², Neal Patel^{1

2

3}, Jonathan P Wanderer^{1

2

4}, Dara E Mize^{1

2

5}, Jon G Jackson², Thomas J Reese¹, SyLinda Littlejohn², Lorraine Patterson², Tina French¹, Debbie Preston², Audra Rosenbury², Charlie Valdez², Scott D Nelson^{1

2}, Chetan V Aher^{2

6}, Mhd Wael Alrifai^{1

2

3}, Jennifer Andrews^{3

7}, Cheryl Cobb⁸, Sara N Horst⁹, David P Johnson³, Lindsey A Knake^{1

3}, Adam A Lewis¹⁰, Laura Parks¹¹, Sharidan K Parr^{1

2

12}, Pratik Patel¹³, Barron L Patterson³, Christine M Smith³, Krystle D Suszter¹¹, Robert W Turer¹, Lyndy J Wilcox¹⁴, Aileen P Wright¹, Adam Wright^{1

2}

Affiliations

¹ Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² HeathIT, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁹ Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁰ Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹¹ Nursing Informatics Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹² Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹³ Union University College of Pharmacy, Memphis, Tennessee, USA.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Abstract

Objective: We describe the Clickbusters initiative implemented at Vanderbilt University Medical Center (VUMC), which was designed to improve safety and quality and reduce burnout through the optimization of clinical decision support (CDS) alerts.

Materials and methods: We developed a 10-step Clickbusting process and implemented a program that included a curriculum, CDS alert inventory, oversight process, and gamification. We carried out two 3-month rounds of the Clickbusters program at VUMC. We completed descriptive analyses of the changes made to alerts during the process, and of alert firing rates before and after the program.

Results: Prior to Clickbusters, VUMC had 419 CDS alerts in production, with 488 425 firings (42 982 interruptive) each week. After 2 rounds, the Clickbusters program resulted in detailed, comprehensive reviews of 84 CDS alerts and reduced the number of weekly alert firings by more than 70 000 (15.43%). In addition to the direct improvements in CDS, the initiative also increased user engagement and involvement in CDS.

Conclusions: At VUMC, the Clickbusters program was successful in optimizing CDS alerts by reducing alert firings and resulting clicks. The program also involved more users in the process of evaluating and improving CDS and helped build a culture of continuous evaluation and improvement of clinical content in the electronic health record.

Keywords: clinical; decision support systems; electronic health records; evaluation study; quality improvement; user engagement.

MeSH terms

Decision Support Systems, Clinical*
Electronic Health Records
Humans
Medical Order Entry Systems*