The Wide Ranging Issues Surrounding Physician “Alert Fatigue”

MAY 10

The topic of “alert fatigue” has become prevalent since a study by Regenstrief Institute and U.S. Department of Veterans Affairs was published in early April.  The study explores the impact of and effectiveness of alerts generated by electronic medical record and electronic health record systems (EMRs and EHRs).  More specifically, the study focused on medication alerts generated during electronic prescribing (ePrescribing), as they are among the most prevalent alerts sent to clinicians.  While there has been much written about the study’s findings as well as many questions raised regarding how alerts within EMRs and EHRs can be improved, the following is a quick snapshot of the issues and concepts discussed in the study.

Problem: Clinicians are receiving too many alerts when ePrescribing, which is causing them to become “desensitized” to the alerts, and in many cases ignoring them.  In fact, multiple independent studies have shown that clinicians ignore anywhere from 80-95% of the warnings received.  This lack of compliance can significantly jeopardize patient health and safety, as medication-related issues account for roughly 1.5 million adverse health events and cost $177 billion each year in the U.S.

Issues with the alerts: while there are a multitude of potential issues with the current alerts generated by EMRs and EHRs, the following are some of the most relevant faced by clinicians during ePrescribing:

  • Too many alerts being sent
  • Lack of clear understanding of the alert or the importance of the message
  • Alerts causing clinicians to spend too much time tracking down data to assess the validity of the alert as well as how to react
  • Lack of actionable/complete information provided with alerts
  • Alerts contradicting common clinical practice(s)
  • Excessive alert detail preventing clinicians from acting quickly/appropriately
  • Clinicians not understanding why the alert was generated
  • Errant alerts sent to practitioners (e.g., an alert sent to an MD, but intended for the pharmacist)
  • Alert was not specific to the patient and didn’t take into account the specifics of the situation

These issues have led to or helped contribute to the current problem of a lack of alert compliance due to “alert fatigue.”  As a result, multiple groups and entities are exploring ways to improve EMRs and EHRs as well as the overall medication alert process to make alerts more user friendly.  With many options and possibilities currently being explored, there seems to be a consensus to (1) make sure the alerts is patient specific (i.e., related to actual test results or patient history) and (2) eliminate redundant/duplicative alerts.   Being able to successfully do these two things as well as temper or eliminate some of the other issues clinicians face with alerts remains the mystery yet to be solved.

Alert fatigue is one of several topics I’m researching for an upcoming TripleTree report on provider informatics.  If you have any insights in this area, please contact me via the link below!

Jamie Lockhart
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