3 Ways Reviewing Electronic Health Record Quality Metrics Can Improve Overall Efficiency Today

You already know – reviewing real data is the only way to quickly reveal trends and garner insights that improve quality, safety, and patient outcomes along with efficiency, cost savings, and improved operational procedures. At Phrase Health, we want to help you understand the impact of Alerts, Order Sets, and Orders on your quality measures. Here are 3 ways your electronic health record metrics can improve overall efficiency and outcomes today:

Using order set metrics to uncover healthcare inefficiencies

Are your order sets utilized efficiently or do your practitioners circumvent them? Every click beyond an order set not only takes time but risks possible delivery of more expensive, non-standard care.

When the Phrase Health team looked at the metric “number of orders placed outside of an order set within five minutes” to assess its value, we took away the following analysis across several health systems: 

• Order sets for some conditions are more efficient than others
• There are insights to be gleaned on treatment variability based on order set usage
• There is a need to educate practitioners regarding order set usage
  
  

“...by benchmarking your order sets’ performance relative to other health systems, your team can have more informed conversations about what is acceptable ordering variation in support of clinical quality measures.” - Dr. Marc Tobias

Reviewing percent of orders placed from order sets to assess degree of clinical standardization

Healthcare organizations looking to decrease care variation, improve efficiency, and augment quality care delivery track how orders are placed among practitioners. In particular, they can analyze how many orders are placed from curated order bundles like an order set.

The Phrase Health team looked at the metric “% of all orders placed from an order bundle (e.g. order set or order panel) divided by all the orders placed” to assess its value and reviewed: 

• Department-based versus organization-wide analysis
• Year-over-year trends in ordering from 2020 to 2021
• Comparing specialties within an organization and against industry benchmarks

“Quality improvement (QI) and informatics professionals, especially, know that metrics related to uptake of specialty-approved order sets can reflect standardized, high-quality care.” - Dr. Marc Tobias

Reducing fatigue and improving effectiveness of interruptive alerts

Alerts are finely tuned to specific points in the workflow with the aim of influencing behavior. Unfortunately, many hospital informatics and quality improvement teams inadvertently overuse interruptive alerts, fail to as effectively influence behavior, and thus, suffer downstream consequences.

To better understand how interruptive alerts affect care at your facility or within your healthcare system, review two metrics:

1. Override Rate - the number of overridden interruptive firings divided by the sum of non-neutral interruptive firings. 
2. Phrase Burden Index (PBI) - the number of interruptive firings per potentially affected end-user per day.
   
   

“Considerations for the Phrase Burden Index include remembering that there is no magic number regarding a good Index value. It can be particularly useful when looking at the relative impact compared to other deployed alerts when prioritizing where to focus improvement efforts related to clinician burnout.” - Mike Zeidlhack