You Can't Improve What You Aren't Measuring: Advertising CDS Failures Represent the Best of Healthcare

I attended the KLAS Arch Collaborative Learning Summit this week and speaker passionately talked about a powerful truth: you can’t improve what you don’t continuously measure. 

The conference topics were nicely framed by Applied Clinical Informatics’ current special issue on hidden failures in clinical decision support (CDS). Failure is something health systems rarely discuss openly. Yet, these "failures" hold the key to learning and improvement, while reducing burnout and variation.

The cost of ignored failures

The case studies in the special issue reveal the rarely reported reality that’s happening everyday across the country. One case study, based on our work with Temple Health, highlighted a single interruptive alert firing 70 times daily to one physician – overridden every single time for years. Another found a "medications on hold" alert generating tens of thousands of interruptions in a short period with zero clinical benefit. When redesigned as passive notifications, clicks dropped 99% with no impact on patient care. Yet another case study highlights how a simple change in the workflow for an HIV screening alert reduced firings by almost 90% while increasing screenings almost 30%. The stories curated in this issue go on and on as to how an active monitoring program can drive dramatic changes in efficiency and effectiveness.

The pattern is clear: measure the problem, fix the workflow, transform the outcome.

The burnout connection

The friction in the EHR isn't just annoying – it's burning out clinicians. In fact, the entire KLAS Arch Collaborative is premised on this simple idea. The EHR, meant to support providers with vast amounts of data and tools, has become a source of endless typing, clicks, and interruptions. Improving the clinician experience is not just the humane task for leadership, but has downstream financial returns as was highlighted by several speakers. This includes everything from improved retention to optimized reimbursement.

The Arch Collaborative exists because EHR implementations are not the end goal, but just the start of a journey for continuous improvement. Their surveys consistently show that workflow alignment, responsiveness to malfunctions, and proactive tuning directly impact clinician satisfaction and reduce burnout.

The role of clinical informatics and colleagues

Success isn't about more AI or widgets – it involves empowering the small clinical informatics and operational teams who manage EHR workflows and CDS to cover more ground in less time. Not a small feat, but this includes parallelizing optimization efforts with quality, IT, and clinical leadership so that bottlenecks don’t delay or discourage engagement altogether. I’ve seen these bottlenecks so many times that I wasn’t surprised to see it as a core tenant in the Arch Collaborative benchmark.

The formula is simple and foundational to quality improvement methods: measure, learn, adjust, repeat.

The Bottom Line

Discussing CDS failures isn't weakness – it's leadership by showing someone cares to ask: “did that work?” It demonstrates a commitment to measurement, transparency, and continuous improvement. The organizations in this special issue didn't just fix local problems; they provided a roadmap for the entire industry.

At Phrase Health, we're leveraging these insights alongside work from organizations like the Arch Collaborative to transform the EHR and large libraries of CDS from hindrance to help.

Better measurement means better management. Better management means better experiences for clinicians and patients. In healthcare's mission to deliver zero harm, admitting and learning from failures might be our greatest strength.

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