What Are EHR Nudges?
Electronic health record (EHR) nudges are small but powerful design changes that guide clinicians and patients toward better decisions. They work without restricting individual choice. Instead, they reshape how information is presented, making the right action the easiest one. Common nudge formats include default order settings, targeted alerts, and workflow adjustments embedded directly inside the EHR. Together, these tools push clinical behavior in the right direction—quietly, effectively, and at scale.
The concept draws heavily from behavioral science. Researchers have long known that the way choices are framed can significantly influence outcomes. In healthcare, this means a simple default change in an ordering screen can reduce unnecessary imaging, increase statin prescriptions, or improve referral rates for cardiac rehab.
Penn Medicine and Epic Join Forces
Philadelphia-based Penn Medicine is deepening its partnership with Epic to build a broader, smarter library of EHR nudges. Recently, leaders from both organizations met in Philadelphia to explore ways to improve existing nudges and design new ones. Their agenda covered automation enhancements, built-in experimentation frameworks, and tools that allow health systems to share what they have learned across institutions.
This collaboration signals a shift in how leading health systems view the EHR. Rather than treating it as a static documentation tool, Penn Medicine and Epic see it as an active driver of clinical quality. Moreover, the partnership reflects a growing consensus in healthcare technology: the EHR must evolve from a billing and charting system into a genuine care delivery platform.
How Nudges Work in Clinical Settings
Default Options That Drive Better Care
One of the most effective nudge formats is the default order. Penn Medicine previously implemented a default imaging setting that eliminated daily scans for patients undergoing palliative radiotherapy. Physicians could opt out, but the default guided most toward the better, lower-burden choice. The result was a statistically significant reduction in unnecessary imaging.
Alerts and Workflow Adjustments
Alerts are another key nudge format. However, poorly designed alerts often backfire—one study found that 80 percent of EHR-based heart failure medication alerts were ignored or suppressed. Penn Medicine’s approach focuses on placing alerts at the right moment in the workflow, for the right clinician, with clear context. This targeted design reduces alert fatigue and improves response rates.
Clinician-Directed Reminders
Penn Medicine also uses clinician-directed nudges for preventive care. For example, MRI ordering for women with extremely dense breasts increased by 80 percent following the introduction of targeted EHR nudges. Similarly, multi-component nudges—including pended orders—significantly raised mammogram completion rates in a clinical trial.
Scaling From 10 to 10,000 Nudges
Perhaps the most ambitious goal emerging from the Penn Medicine–Epic collaboration is scale. Srinivas Sridhara, PhD, Chief Data and Analytics Officer at Penn Medicine, put it plainly: “There are not just tens, hundreds, or thousands of these evidence-based practice measures that we could implement.” His fundamental ask to Epic was direct — help Penn Medicine go from implementing 10 nudges to 10,000.
This goal requires more than good ideas. It demands automation, systematic experimentation, and infrastructure that allows nudges to be tested, refined, and deployed across multiple health systems simultaneously. Better tools for sharing learnings between organizations are also central to achieving this vision.
The Role of Behavioral Science
Penn Medicine’s Nudge Unit — widely recognized as the first behavioral design team established within a health system — sits at the center of this work. Founded on the principles popularized by Richard Thaler and Cass Sunstein, the unit applies behavioral economics to clinical workflows. Furthermore, it treats EHR design as a behavioral intervention, not just a technical one.
David Asch, MD, Executive Director of the Penn Medicine Center for Health Care Innovation, has consistently argued that behavioral economics applies equally to patients and clinicians. Physicians, like all people, respond to how choices are framed. Therefore, designing the EHR to subtly favor evidence-based actions can produce meaningful, lasting changes in care delivery.
The Nudge Unit organizes an annual Nudges in Health Care Symposium that draws hundreds of researchers, clinicians, and executives from dozens of institutions globally. This year’s event highlighted growing interest in combining AI with nudge design—using machine learning to personalize nudges based on patient characteristics and clinician behavior patterns.
Real-World Results and Impact
The evidence for EHR nudges is growing steadily. Across Penn Medicine’s experience, nudge interventions have:
- Increased statin prescriptions for cholesterol patients through smarter ordering defaults
- Improved cardiac rehab referrals following heart attacks
- Reduced unnecessary advanced imaging by restricting orders to appropriate cases
- Boosted cancer screening rates through clinician-directed reminders embedded in the EHR
Crucially, these results come without mandating behavior. Clinicians retain autonomy. The nudge simply makes the recommended action easier to take than the alternative.
What Comes Next
The Penn Medicine–Epic partnership points toward a future where EHR nudges are not one-off projects but a continuously evolving, evidence-based system. With automation, shared learning infrastructure, and AI-assisted personalization on the horizon, health systems may soon deploy nudges at a scale previously unimaginable. Additionally, the focus is shifting toward equity—ensuring that nudge-driven improvements in care reach all patient populations, not just the most connected ones.
As health systems continue to invest heavily in EHR technology, nudges offer one of the clearest paths to demonstrating clinical and financial return. Penn Medicine’s ambition to scale from 10 to 10,000 nudges may well define the next chapter of evidence-based healthcare delivery.
