If you use Eclinicalworks in your practice, you already know that its clinical decision support (CDS) alerts can be a double-edged sword. When they’re right, they catch things that matter—missed vaccines, risky meds, overdue screenings. But when they’re wrong, they’re just screen clutter, wasting your time and annoying your staff. If you work in a specialty, generic alerts can miss the mark even more. This guide is for anyone who’s tired of “one-size-fits-all” CDS and wants to make Eclinicalworks work for their actual patients and workflows.
Why Bother Customizing CDS Alerts?
Let’s be honest: Most out-of-the-box CDS alerts are built for primary care. They’ll tell your pediatrician about mammograms and your cardiologist about childhood vaccines. You probably ignore a lot of them. Over time, you and your staff get “alert fatigue”—clicking past everything, which defeats the point.
Customizing CDS alerts means: - Less noise, more signal. Only see what matters for your specialty. - Fewer missed opportunities. Surface reminders and warnings relevant to your patients. - Happier, less frustrated staff. (And maybe fewer eye rolls at the computer.)
Before You Start: What You Can—and Can’t—Change
Here’s the straight talk: Eclinicalworks (eclinicalworks.html) isn’t the most flexible system in the world, but it does let you set up custom alert rules, tweak existing ones, and suppress the stuff you don’t need. You can: - Enable or disable most system alerts for your whole practice or by provider. - Create custom CDS rules using diagnoses, meds, labs, demographics, and more. - Fine-tune when (and how) alerts pop up.
But you can’t: - Change core system logic for some “hardwired” alerts. - Get super-granular with workflow-triggered alerts (like only at check-in, etc.). - Easily change alert visuals or create your own fancy pop-ups without IT support.
Step 1: Figure Out What You Actually Need
Don’t just start clicking. Take an hour to answer these questions: - What alerts do you see now that are useless (for your specialty)? - Are there important things you wish the system would alert you to? - What triggers—meds, labs, diagnoses—actually matter for your patients? - Who needs which alerts? (Docs, NPs, nurses... everyone or just some roles?)
Pro tip: Ask your staff what alerts they ignore or wish they had. They’re the ones who live with them all day.
Step 2: Review and Turn Off (or Suppress) Irrelevant System Alerts
Here’s where you start cleaning house.
- Log in as an administrator. (You’ll need rights to change global settings.)
- Go to the “CDS Administration” or “Decision Support Settings” area. The exact menu name can change by version.
- Find the list of system alerts (sometimes called “health reminders”).
- For each alert, decide:
- Is this relevant to your specialty?
-
Do you need it at all, or just for some providers?
-
Disable or suppress alerts that don’t fit. In most versions, you can:
- Uncheck global settings for things like “Colonoscopy Reminder” if you’re not a GI practice.
- Limit alerts to certain provider types.
- (Optional) Set “snooze” or “remind later” intervals for alerts that aren’t urgent.
What to ignore: Don’t waste time tweaking every single alert. Focus on the top 10–20 that come up most often.
Step 3: Create Custom Alerts for Your Specialty
This is where things get interesting. Eclinicalworks lets you create custom CDS rules based on all sorts of triggers. Some ideas by specialty: - Endocrinology: Alert if last A1C >9% and no med change in 3 months. - Pediatrics: Catch missed 2-year-old immunizations. - Cardiology: Flag patients on ACE inhibitors who haven’t had a recent potassium check.
How To Build a Custom Rule
- Go to the CDS/Health Reminders setup. Look for “Add New Rule” or “Custom Alert.”
- Enter a clear, specific name. Something like “Annual A1C for Diabetics.”
- Set your criteria. This is the “if” part. You can usually combine:
- Diagnoses (ICD-10 codes)
- Medications (drug classes or names)
- Lab results (values, dates)
- Demographics (age, sex, etc.)
-
Visit types (office visit, telehealth, etc.)
-
Define your action. This is what the alert tells you to do—order a test, review a med, schedule a follow-up, etc.
- Choose your audience. Decide if the alert should show up for all providers, just MDs, or specific roles.
- Set frequency/recurrence. How often should the alert pop up? Only at annual visits, every time, or just once?
Don’t overdo it: The more custom alerts you create, the more likely you’ll just re-create alert fatigue. Stick to things that are truly important.
Step 4: Test Your Alerts—In Real Charts
Before rolling out new or changed alerts to everyone, test them on a few real (or test) patients. Don’t trust the “simulation” tools—they’re often buggy or don’t show the full context.
- Open a patient chart that should trigger the alert. Does it pop up as expected?
- Try a chart that shouldn’t trigger. Is it quiet?
- Check with different user roles—sometimes alerts show (or don’t show) for nurses vs. providers.
If something doesn’t work, double-check your logic. Eclinicalworks’ rule-builder isn’t always intuitive—sometimes “AND” and “OR” logic trips people up.
Step 5: Roll Out Gradually and Collect Feedback
Don’t flip the switch for everyone at once. Start with a small group—maybe just your specialty team or a few providers.
- Give them a week or two to use the new setup.
- Ask what’s helpful, what’s annoying, and what’s missing.
- Be ready to tweak. No one gets it perfect on the first try.
Pro tip: Keep a simple spreadsheet to track which alerts you’ve changed, who asked for them, and any complaints. It’ll save you time later.
Step 6: Maintain and Update Alerts Regularly
Clinical guidelines change, and so do your workflows. Make it a habit—maybe twice a year—to review your CDS alerts.
- Retire alerts that aren’t useful anymore.
- Add new ones if you spot care gaps.
- Clean up any “temporary” rules that never got removed.
Most practices ignore this step, and pretty soon, alert fatigue creeps back in.
What Works, What Doesn’t, and What to Skip
What Works
- Custom rules tied to your specialty’s bread-and-butter conditions.
- Suppressing irrelevant system alerts—nobody needs a pap smear reminder in urology.
- Giving staff a say in what gets turned on or off.
What Doesn’t
- Overly broad or vague alerts (“Consider further evaluation if appropriate”).
- Trying to automate every clinical judgment—use alerts for things that are black-and-white.
- Relying on Eclinicalworks’ documentation alone—it’s often outdated or too generic.
What to Skip
- Chasing every new “alert enhancement” feature unless it actually solves a real problem.
- Making alerts for things your team already does reliably.
Final Thoughts: Keep It Simple, Tweak Often
You’re never going to get every alert perfect, and that’s fine. The goal is to cut the noise, surface what matters, and avoid burning out your team with endless pop-ups. Start with the basics, listen to your staff, and make small changes as you go. Eclinicalworks may not be the most user-friendly system around, but with a bit of effort, you can make CDS work for you—not against you.