Electronic Medical Records Pop-Ups Can Lead to Alert Fatigue

A new study identifies some of the reasons for alert fatigue, where providers can become desensitized and may start unintentionally ignoring some important warnings.

Researchers at the Regenstrief Institute (Indianapolis, IN, USA) and the US Department of Veterans Affairs (VA; Washington DC, USA) conducted an empiric study, following 30 doctors, nurse practitioners, and pharmacists as they treated 146 patients in a variety of outpatient clinics at the Indianapolis (IN, USA) VA center from August 2008 to August 2009. Prescribers were observed in situ as they ordered medications for patients and resolved alerts. In all, the researchers collected 351 pages of typed notes across 102 hours of observations and interviews. An interdisciplinary team identified emergent themes via inductive qualitative analysis.

The results showed that overall, 320 alerts were observed. Qualitative analysis uncovered 44 emergent themes and 9 overarching factors, which were organized into a framework that describes the prescriber-alert interaction. The nature of the alerts and responses were used to identify factors that influence how well the alerts work, including the content of the alert, the pharmaceutical knowledge needed to understand it, and how it is displayed on the computer screen. The researchers noted that improperly designed alerts may cause prescribers to overlook important alerts due to too many alerts, too much extra information, or that the alert does not apply to the patient.

Prescribers were sometimes unsure why an alert was appearing, especially in cases where the alert appeared to contradict common clinical practice. The prescribers said they wanted more patient-specific alerts, such as those that are triggered by a patient's lab values, but they disliked repetitive or redundant alerts. The timing of alerts was also mentioned as a barrier that interrupted the prescribing process, and could not be postponed or dealt with later; on the other hand, there was no way to retrieve alerts that had been dealt with and then had vanished from the screen. The study was published in the April 2012 issue of the International Journal of Medical Informatics.

“Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems,” said lead author Alissa Russ, PhD, of the VA Medical Center in Indianapolis. “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.”

Related Links:
Regenstrief Institute
US Department of Veterans Affairs