Patient outreach: build in Epic or buy?
Week-2 Is the Real Test: Why Most Digital Health Tools Don’t Survive It
TL;DR
- Week-2 is the make-or-break. Frontline clinicians decide if a tool fits real workflow by the second week.
- Workflow > features. Tools outside Epic/Cerner, extra logins, or interruptive alerts see rapid drop-off.
- Evidence check. Studies report high CDS alert override rates (often >50% in hospital/clinic settings, various years/contexts) and measurable reductions in login friction with SSO (peer-reviewed + industry data).
- What wins enterprise deals: show where the tool lives in Epic/Cerner and how it reduces steps—not adds them.
Get the 3-min Evidence Brief • See Epic/Cerner Workflow One-Pager
Why “go-live” looks fine—but week-2 stalls adoption
Most digital health pilots don’t fail on launch day. They fail in week-2—when frontline clinicians decide if the tool fits their workflow.
Executives may see early enthusiasm. But by the second week, if the solution adds logins, interrupts care, or lives outside Epic/Cerner, frontline use drops. Once that happens, Value Analysis Committees (VACs) start asking if the tool is delivering measurable impact.
Frontline findings: “If it isn’t in Epic, it isn’t real”
“If it isn’t in Epic, it isn’t real.”
“Week-2 is when tools die.”
Interviews with nurse informaticists and care managers echo this. Implementation research similarly highlights workflow integration as a key predictor of adoption across settings and studies.
The alert-fatigue trap
Interruptive alerts can look great in demos—but real-world use tells another story:
- High override rates. Multiple studies in inpatient and outpatient settings observed that a majority of medication-related CDS alerts are overridden; appropriateness varies by alert type and context.
- Habit formation by week-2. If your tool generates too many non-actionable prompts, clinicians will ignore them—often permanently.
Implication: Reduce interrupts, prioritize in-workflow, high-specificity nudges, and show exactly who sees what, where, and when.
Logins decide usage: SSO vs. abandonment
Every extra login step compounds risk. Clinicians already spend hours in the EHR. Extra clicks and context switches increase burden and erode adoption.
- Single Sign-On (SSO) helps. Peer-reviewed and industry analyses have associated SSO with reduced login time and smoother session re-entry, reclaiming staff minutes at scale.
- Leaving Epic/Cerner kills flow. If use requires jumping to another app or juggling credentials, week-2 is where usage collapses.
Why APIs and workflow visuals matter now
- Policy raised the floor. ONC’s Cures Act and HTI-1 updates strengthened API-based interoperability expectations (e.g., FHIR/SMART-on-FHIR within certification criteria), reinforcing buyer scrutiny of how you integrate.
- Market transparency. Epic’s Connection Hub and Showroom let health systems verify which apps embed into workflow. “We integrate” is now verifiable.
- Vendor takeaway. Don’t just claim “Epic/Cerner integration.” Show the map: where it launches (Storyboard, In Basket, Order Composer, BPAs), who owns it (CMIO/CNIO/IS), and what steps it replaces.
Evidence snapshot (qualified)
- CDS alert overrides: Studies in hospital and ambulatory settings recorded override rates commonly >50% for medication-related alerts; appropriateness varies by alert type and clinical context. Methods → see References
- SSO and login friction: Peer-reviewed evaluations and independent analyses associated SSO with measurable decreases in login and reconnect times, translating to reclaimed staff time. Methods → see References
How it works in the EHR (Epic/Cerner)
Where it lives: Embed where clinicians already are (e.g., Epic Storyboard, Synopsis, In Basket, Orders; Cerner MPage, PowerChart components). Use SMART-on-FHIR or native extension points—no new login.
Ownership: Clinical sponsor (CMIO/CNIO) + operational owner (care management/quality) + IT integration lead. Define monitor(s) for adoption and safety.
No new credentials: SSO + context-aware launch; keep identifiers and patient context intact.
Implementation: steps, risks, and what to measure
- Map the workflow. Show current vs. future steps. Identify where clicks are removed.
- Integrate natively. Use FHIR/SMART launch points; avoid swivel-chairing.
- Tune alerts. Start with conservative thresholds; monitor overrides and adjust.
- Train fast, in-flow. 10-minute tip sheets; 1-page “where it lives” visual.
- Measure weekly. Track adoption (eligible vs. exposed), action rates, time-in-workflow, and safety signals.
What to measure
- Adoption: % of eligible encounters where the tool was used (week-1 vs. week-2, then weekly).
- Efficiency: clicks/keystrokes removed; median time to complete task.
- Outcomes (directional): PMPM, readmissions, LOS, or handoff defects—reported with population, timeframe, and setting.
Frontline Buy-In — 7 checks
| Check | What “good” looks like |
|---|---|
| 1) In-EHR location | Lives in Epic/Cerner where work already happens (no app-switching). |
| 2) No new login | SSO + context-aware launch; patient context persists. |
| 3) Fewer clicks | Documented step reduction vs. current state. |
| 4) Alert strategy | High-specificity nudges; monitored override rates; tuned thresholds. |
| 5) Ownership | Named clinical + operational + IT owners; forum to adjust. |
| 6) Evidence | Qualified metrics (population, setting, timeframe) + Methods sheet. |
| 7) Week-2 plan | Adoption review in week-2; changes shipped within 1–2 sprints. |
Conclusion: Adoption is workflow, not features
Week-2 adoption isn’t about shiny features. It’s about whether frontline staff see the tool as part of their normal flow. Fit inside Epic/Cerner matters. Extra logins and interruptive alerts erode use. Committees reward vendors who show evidence and workflow integration.
Next steps for vendors
- Evidence brief (3-min): Methods, outcomes, and adoption data in plain language.
- Epic/Cerner workflow one-pager: Visuals showing exactly where the tool fits.
- Security packet: HITRUST/BAA readiness details to accelerate IT review.
Download Evidence Brief See Epic/Cerner Workflow Request Security Packet
FAQ
What counts as “in-workflow” integration?
Launching within Epic/Cerner (e.g., Storyboard tile, MPage component) with patient context and SSO—no separate credential entry, no copy-paste.
How do we reduce alert fatigue without missing risks?
Start with high-specificity rules, monitor override rates weekly, and iteratively tune. Provide non-interruptive cues where safe; reserve interrupts for high-risk scenarios.
What proof do VACs expect?
A brief Methods sheet (population, timeframe, setting, analytic approach), a workflow map showing step reduction, and early adoption metrics (week-1 vs. week-2).
Is SMART-on-FHIR mandatory?
Certification updates strengthen API expectations; many buyers now assume SMART-on-FHIR or native extension points for launch and data exchange. See References.
How fast should we see impact?
Focus on leading indicators first (adoption, step reduction, time saved). Outcome signals (e.g., readmits) typically need larger cohorts and longer windows. Avoid promises; report directional changes with context.
References & Methods
Notes: Numbers above are directional and context-dependent. See sources for settings, populations, and periods.
- AHRQ PSNet. Medication-related CDS alert overrides (inpatient & outpatient summaries), various studies. 2014–2018+.
- Nanji KC, et al. Override rates of medication CDS alerts (multiple alert types). PubMed indexed. 2014; 2018.
- AHRQ Effective Health Care Program. Computerized CDS—rapid research synthesis (alert overrides & unintended consequences). 2024.
- Gellert G, et al. Clinical/financial value of workstation SSO; peer-reviewed analyses of login reductions. 2017; 2019.
- ONC. HTI-1 Final Rule overviews and API guidance (FHIR/SMART launch expectations within certification criteria). 2023–2024.
- Epic. Connection Hub / Showroom—public directory of live Epic connections and app categories. Ongoing.
- Implementation science on workflow integration and adoption (e.g., WIS validation; workflow as predictor of meaningful use). 2010–2011.
Equip your team for week-2
Show evidence and workflow fit in the first meeting.
Download the 3-min Evidence Brief Get the Epic/Cerner Workflow PDF