The Health Hazard of EHR Alerts

According to a report in Kaiser Health News (KHN), healthcare providers are facing a syndrome called “EHR alert fatigue”—doctors, nurses, and pharmacists who work with electronic health records, or EHRs, are constantly alerted based on flags within a patient’s health information. These alerts could range from patient allergies, to drug interactions, to the prescription of a potentially addictive painkiller. Turns out, clinicians ignore safety notifications 49% to 96% of the time!

Can you blame them? For a busy healthcare clinician who has just about enough time to spend the allocated 15 minutes with the patient, being bombarded with a ton of what could in essence be irrelevant information could result in ignorance.

This definitely isn’t a new development. A study conducted by researchers at the Department of Veteran’s Affairs, back in 2012, found that prescribers’ ability to act on medication alerts were driven by the alert interface being used. Overall, of the 30 prescribers who were included in the study, 320 alerts were observed, with 44 emergent themes and 9 overarching factors—this provides a perfect example of the reactionary variance to these alerts, based on the provider and a particular patient.

Many hospitals are documenting this pattern of physician reaction to customize the alert systems in their EHRs. Research is also being conducted to maximize the education potential of EHRs, while trying to reduce the risk associated with excessive alerts. This of course would require providers, software vendors, and health information technologists to work together on developing these interfaces.

“This is an issue that everyone’s going to have to wrestle with eventually,” Bill Marella, executive director of patient safety operations and analytics at ECRI Institute, told KHN.

There definitely are consequences of ignoring alerts, according to the KHN report. When the Children’s Hospital of Philadelphia (CHOP) implemented a new EHR, the number of alerts in the system skyrocketed—and physicians were overriding most of these alerts. This resulted in one such warning about a patient’s response to a drug being ignored, and the patient was subsequently administered a medication with a potentially lethal reaction. Although timely action saved the patient, the incident spurred pharmacists and care providers at CHOP to sort through and turnoff irrelevant alerts, according to KHN.

According to Bret Shillingstad, MD, FACS, a physician on the Clinical Informatics team at Epic Systems Corp, they have included functionality in their EHR systems for hospitals to turn off these alerts. They are also working to personalize the software so that it matches a patient’s health condition.

“Because it’s so easy to put an alert to address a problem, that’s people’s natural, knee-jerk reaction,” Douglas Gentile, medical director of clinical information systems at the University of Vermont Medical Center, told KHN. But “as you add those, it creates additional problems. And you get collateral damage.”