Optimization of Medication Point-Of-Prescribing Alerts at a Multi-Site, Ambulatory Care Organization to Aid Clinical Care and Reduce HealthCare Cost

Abstract

Background Literature has shown the integration of electronic alerts into patient care has the potential to improve clinicians’ workflow by saving time, increasing efficiency, and improving patient safety. However, despite these possible benefits of alerts, studies have shown that alerts are often overridden by clinicians. Objective: The purpose of this study was to optimize the acceptance rates of medication point-of-prescribing alerts within the electronic medical record (EMR) of an ambulatory care organization. Methods: The study design evaluated the actions taken by clinicians when they were presented with medication point-of-prescribing alerts. These alerts were created by the clinical pharmacy informatics team to help promote cost-effective and safe prescribing. Alerts determined to be high value alerts were optimized to increase clinicians’ likelihood of accepting each alert’s recommended alternative. The primary objective was to increase acceptance rates of high value alerts. The exploratory objective was to identify the estimated annualized cost-savings when high value alerts were accepted, and a lower cost alternative prescription resulted. Results: The acceptance rate of the optimized point-of-prescribing alerts increased to 8.7%, compared to a 3.2% acceptance in the pre-modification period (P <.001). The lower cost alternative prescriptions that resulted from the accepted alerts translated into an estimated annualized cost-savings of over 2 million dollars. Conclusion: The use of point-of-prescribing alerts with optimized information and specific cost comparisons in an ambulatory setting led to an increase in the acceptance rates of the alerts and more cost-conscious prescribing.