Optimizing EMR Hard Stops For Improved Patient Safety, Reduced Clinician Burnout & Enhance Care
Ensuring patient safety is the foremost responsibility of any facility providing medical care. While hard stops in the electronic medical record (EMR) are designed to support this effort, they can also contribute to inefficiency and physician dissatisfaction. If not set-up appropriately, hard stops can even prove detrimental to patient care.
Understanding Hard Stops In The Emergency Room
The fast-paced, often chaotic environment of the emergency department is marked by complexity and heightened risks that aren’t always found in other hospital departments or outpatient clinics.
ER administrators and clinical teams use hard stops to prevent mistakes by keeping physicians and nurses from proceeding any further with an assessment or treatment through the EMR. However, as everyone in health care knows, time spent in the EMR is a major cause of clinician burnout. And no matter how well-intentioned, hard stops add to the documentation burden.
“On the good side, hard stops can prevent errors and can trigger the clinical team to identify issues early,” explains Eric Wilke, MD, Chief Operations Officer for TECHealth. “Some of the downsides with hard stops, though, are that if you have a ton of them, it frustrates the clinical user because it slows down their ability to document.”
He points to a retrospective study in the Journal of the American Medical Informatics Association underscoring the balance needed. The research evaluated dozens of previous studies on hard stop alerts in clinical settings.
While it revealed that hard stops were superior to soft stop in improving outcomes in 75% of the studies evaluated, it also uncovered unintended consequences ¾ findings which other research supports. These include alert fatigue, increased cognitive burden on clinical team members and order delays when time is a critical factor.
It’s worth noting that some hard stops are set-up with an eye towards optimizing billing. For instance, they’re used to comply with CMS best practices particularly around sepsis screening, which can impact payment—either through penalties or incentives—based on performance.
“You’ve got to be judicious with how you use hard stops,” says Dr. Wilke. “For example, a lot of them are triggered by medication interactions and give an alert for every possible medication interaction, most of which are trivial. So, the doctor will just click through ignoring all the alerts.”
Beyond being an irritant, this can lead to a significant drug interaction being missed.
Improving EMR Hard Stop Efficiency With Collaboration
Research into making the best use of hard stops in the emergency room and other care settings highlights the importance of working closely with end users—physicians and nurses—as well as setting up an iterative process. In other words, don’t set it and forget it. A constant feedback loop with significant user involvement is crucial.
“You need to involve several people when setting up the EMR. You need to involve the clinical team and the compliance team to walk through which hard stops to activate and which hard stops to ignore,” says Dr. Wilke.
Some questions administrators and IT teams need to be able to answer not just when implementing an EMR but on an ongoing basis include:
- Has your EMR set-up opened the door to potential safety issues in the ER or other care settings?
- What technology solutions have you considered to ameliorate potential safety issues caused by technology?
- How are you involving end-users (i.e., physicians and nurses) in adjusting hard stop settings in your EMR?
- What’s your strategy for addressing alert fatigue?
- How are you lowering the documentation burden on clinicians?
An ER-Centric EMR Solution
Having worked as a physician and administrative leader in the ER, Dr. Wilke understands how critical having the right EMR and having it set-up correctly is in optimizing both patient safety and clinician experience.
TECHealth developed its electronic medical record, TECdoc to be highly customizable based on the needs of ER providers and administrators. TECdoc is both a standalone EMR solution and can seamlessly interface with a healthcare facility’s host EMR.
“With the EMR we wrote it for emergency rooms, we were thoughtful in what out-of-the-box hard stops to include,” says Dr. Wilke. “What we’re trying to do is that instead of adding some hard stops, is to use AI to present information or recommendations to the physician and find gaps that need to be covered.”
The TECHealth team works closely with ER care providers to build a solution that’s the right fit not only from a clinical and compliance perspective but a cultural one as well.
“We’ve been pleased with the response,” says Dr. Wilke. “It’s been well-liked by clinicians and has just enough hard stops to hit the critical items.”
To learn more about how TECdoc can improve patient care while keeping care teams happy, visit us online at tec.health/tecdoc-emr/.
