As EHRs become more widely accepted, physicians are finding out that with the convenience and efficiency they provide come a few headaches and stumbling blocks.
Complaints of alert fatigue are starting to rise among EHR providers and hospitals. People entering commands into the systems are finding that an overabundance of medication-related warnings and alerts must be seen, clicked through, or ignored before their order is accepted.
A recent study published in the April issue of the International Journal of Medical Informatics examined how clinicians react to medication alerts generated by modern EHRs. The main purpose of the Indianapolis’ Regenstrief Institute and the U.S. Department of Veterans Affairs study was to “uncover factors that influence the prescriber–alert interaction and identify strategies to improve alert design.”
Field researchers observed and interviewed 30 doctors, nurse practitioners and pharmacists across five primary care clinics and eight specialty clinics. These providers treated 146 patients and received 320 medication alerts, including warnings about patient allergies and drug interactions. An interdisciplinary team then analyzed the data in search of consistent patterns or themes.
One theme that emerged from the research was that many medication prescribers were unsure of the reason why a particular alert was being generated. Many of the alerts being generated were more pharmacy-oriented, even though the software was being used at the point of prescription.
“Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems,” co-author Alissa Russ said. Russ is a research scientist with the Center of Excellence on Implementing Evidence-Based Practice at Indianapolis’ Richard L. Roudebush VA Medical Center.
Another study published in the Journal of Informatics in Health and Biomedicine by a research group in the Netherlands, showed that clinicians there typically override from 49 to 96 percent of EHR drug safety alerts. The report added that “a distinction between appropriate and useful alerts should be made” by the EHR system.
“Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as EMR systems expand beyond single hospitals and share more data,” Russ said.
The researchers also found that prescribers spent a large amount of time researching data and information in response to an alert. One possible solution might be to have the alert refer the user to the relevant documentation or the particular data that is causing the warning to be generated.
Smarter alerts might be one solution, but reducing the amount of them could prove difficult for now as another study published in the December issue of Health Affairs showed EHR vendors “sharply limit the ability to modify alert systems because they fear being exposed to liability.”
“(To) limit liability in this area,” the report continues, “we recommend stronger government regulation of clinical decision support systems and development of international practice guidelines highlighting the most important warnings.”
As anyone who follows politics knows, changes in government policies and regulations can take months or years to adapt to problems within a particular industry. With American politics currently stuck in the gridlock of a presidential election year, it is unlikely changes to EHR regulations will occur before 2013.