Optimizing Electronic Health Record Prompts With Behavioral Economics to Improve Prescribing for Older Adults

An alert will display in the electronic health record when the provider orders one of the high-risk medications for an eligible patient.

An alert will display in the electronic health record when the provider opens the chart of an eligible patient.

Once the order entry or open encounter alert displays, the provider will have the option to schedule a follow-up message that will be sent 4 weeks after the alert is triggered

An in-basket message will be sent to the eligible provider 2 days before the eligible patient is scheduled for an in-person visit.

The alert language itself will be simplified.

An alert will display in the electronic health record when the medication is sent to sign-off for providers.

A two-staged pre-commitment electronic health record alert will be used. In the 1st alert, the providers will be prompted to discuss risks of these high-risk medications and share a handout about the risks with their patients, at their own discretion. The second alert will be either an order entry or open encounter alert, depending on the arm the provider is assigned to.

Risks of the high-risk medications will be framed differently.

This alert will be representative of the alerts currently firing in the Atrius system and not incorporate any functionality.

An enhanced alert (known as a Best Practice Advisory \[BPA\]) will appear on the provider's electronic health record screen and will contain several standard components such as information about why the medication is dangerous for their patient and an order set that will allow providers to order a gradual dose taper for their patient, order alternative medications, place a referral to a behavioral health specialist, provide instructions on how to make lifestyle modifications to improve patient symptoms, and add patient instructions for how to gradually taper off benzodiazepines and sedative hypnotics, as applicable.