Using BPAs to Improve Care

Yale is in the process of activating some of the clinical Best Practice Alerts (BPAs), Epic’s version of medical logic modules, which were not turned on during the go-live. “As we get feedback and experts determine whether an alert is useful or clinically relevant, we are fine-tuning them,” said Hsiao. The Epic team is conscious of alert fatigue and has turned off or dialed down alerts that fire too often. At the same time, team members are eager to provide clinicians with this quality improvement tool.

One example of how BPAs might be used to improve care is a pilot BPA related to smoking cessation. Steven Bernstein, M.D., professor of emergency medicine and a leading expert on tobacco cessation, wanted to determine whether computerized decision support would help patients quit smoking. He obtained a grant for a research study in which physicians are randomized to receive computerized decision support when caring for patients who smoke.

When a patient is identified as a smoker in Epic and admitted to internal medicine at YNHH, physicians in the intervention arm receive an alert in the patient’s EMR prompting them to consider ordering a smoking cessation medication. The alert contains a link to the suggested order set for dosages in order to make it as easy as possible to order the intervention. The alert also goes one step further by automatically sending a note to the primary care physician on record in the Yale system; sending an alert to Connecticut’s Tobacco Quitline, which provides resources and encouragement to stop smoking; and adding tobacco use to the patient’s list of problems.

“To our knowledge, no one on Epic has done something like this before, because it actually does things proactively,” said Hsiao. “Our hope is that all of these things combined will help physicians help patients quit smoking.”

Hsiao and his colleagues are interested in using BPAs to assist investigators conducting research in recruiting patients. The ultimate goal is to feed information from Helix (see “Epic & Clinical Research,” ) and OnCore into a BPA that can help investigators hone in on eligible subjects for research studies. Investigators who would like to propose a research-related BPA pilot may contact Allen Hsiao at