Challenges with the usability of electronic health record (EHR) systems can detract from safe care. For example, alert fatigue associated with EHR alerts contribute to physician burnout and can contribute to medical errors.

Researchers at Vanderbilt University Medical Center (VUMC) developed the Clickbusters initiative to improve optimization of their EHR system and reduce clinician burnout by improving programmed clinical decision support (CDS) alerts. Using the Plan-Do-Study-Act model, the Clickbuster initiative assesses the performance of CDS alerts to identify potential alert modifications (see figure)

Prior to the Clickbusters initiative, VUMC had 419 programmed CDS alerts which resulted in 488,425 firings each week. Researchers conducted two rounds of Clickbusters with clinical directors, clinician champions and other individuals interested in health informatics; participants selected one or more of the programmed alerts and assessed alert performance using the 10-step Clickbusters process. Across both rounds, 84 alerts were analyzed; the Clickbusters process resulted in modifications to 42 alerts and 10 alerts were turned off. These changes eliminated (“busted”) 71,227 weekly alerts, or 15% of all pre-Clickbusters weekly alerts.