One of the innate advantages of the implementation of electronic health records (EHRs) is the ability for the technology to coordinate and analyze data for physicians. This is especially applicable during the diagnosis and prescription-writing process of a doctor’s appointment. The goal of the record system is to keep patients safer by alerting doctors when one of their choices may not be in the patients’ best interest.
For example, if a patient is currently taking one medication on a daily basis, and the physician prescribes a secondary medication that would react poorly with the first, an automatic alert sounds or appears on the system’s screen. The physician has the opportunity to review his or her medication selection and potentially make a substitution that would be a better option for the patient. This helps the EHRs maintain their meaningful use as required by law.
However, recent studies of doctors and their practices have concluded that doctors are ignoring up to 91 percent of the alerts that they are receiving without examining the cause of the alerts. This is alarming for patients who rely on their physicians to give them the best possible care. With these kinds of statistics, the question remains: Why are doctors ignoring these life-saving alerts?
Causes of Alert Fatigue
With a startling figure like 91 percent of alerts are ignored, researchers were compelled to delve deeper into the reasons behind this seemingly unprofessional behavior. What they found is that there are a number of reasons that doctors are choosing to disregard and override their EHR alerts:
1. The volume of alerts is out of control. When a physician orders a prescription medication for a patient, that patient’s file is shared with the health practitioner who is assisting the physician and the pharmacist who is filling the prescription. An alert for that patient could occur at any time during the prescription process, even if the physician saw the patient several hours earlier. Most physicians see multiple patients during the day, and when they receive alerts for all of them, they begin to ignore the alerts.
2. Many of the alerts are unnecessary. The EHRs are programmed to be overly cautious for the safety of the patients, and many of the alerts that are generated have been found to be false positives that do not indicate actual problems for the physicians to address. The high level of unnecessary alerts causes many doctors to disregard them without even considering the possible causes.
3. The alerts often interrupt the physician’s workday. Because many of the alerts are delayed and not actually occurring while the doctor is in the room with the patient, the timing can actually interrupt an appointment with another patient. Similarly, a physician might receive an alert while he or she is trying to enter information into the EHR system, causing him or her to cancel the alert just to get it off the screen.
4. Too many alerts seem completely extraneous to the patient. In their studies, researchers found that many of the alerts generated by the EHRs are irrelevant to the patient. For example, one alert might remind the doctor to check whether the patient could be pregnant before prescribing a medication, but the doctor knows that the patient is male. Similarly, comatose patients are causing physicians to receive alerts that their patients might be at risk of falling. These types of alerts are unrelated to the patient, and the doctors frequently ignore them.
What This Means for EHR Alerts
As physicians and their practices continue to implement EHRs and alert systems, there needs to be adjustments and improvements made to the process. It is not safe for doctors to use alert fatigue as an excuse for ignoring life-saving notifications. At some point, this constant inclination to override and continue without reading the alerts will eventually lead to missed diagnoses, poor medication interactions, and possible detrimental effects on patients. With reconfigured support in the EHR systems in addition to customizable alerts, physicians and their staff members can shape their own alert systems in a way that will work for them while improving patient care. The implementation of automatic EHR alerts has the potential to save patients’ lives with improvements that will prevent physician alert fatigue.