How one hospital tweaks its EHR to fight alert fatigue

How one hospital tweaks its EHR to fight alert fatigue

Each month, ‘we were seeing about 150,000 alerts’

In Healthcare IT News‘ July cover story, which explores new and innovative approaches to clinical decision support at a time where it’s needed more than ever, one healthcare professional voiced a common complaint about electronic health records: the near-constant, often-annoying profusion of system alerts.

Too often, when clinicians think of CDS, “they think of a pop-up alert: something that, in the middle of what you’re doing, gives you a piece of information that the technology thinks is important and wants you to do something to fix,” said Gregory Paulson, deputy director of programs and operations at New Jersey-based Trenton Health Team.

But technology doesn’t always know best.

Paulson offered an analogy: “To me, it’s the equivalent of going online to shop on a website or pay your bill and getting these pop-up adds,” he says. “If you’re shopping on Amazon and you do it frequently, obviously you know where to click. You’re familiar with that website you know how to interface with it in a way that is seamless. So if I then institute a pop-up alert – one that interrupts your process when you’re not expecting it and you don’t want to stop – you’re not going to want to shop at Amazon.”

Same goes for physicians: The more they’re irritated by unneccesary alerts, the less they like using their EHRs.

While alerts can be life-saving – flagging dangerous drug-allergy interactions or sounding the alarm about inappropriate doses – too many are unneeded, telling docs and pharmacists things they already know.

As AHRQ points out, “Alerts are only modestly effective at best. A systematic review of computerized reminders found only minor improvements in targeted processes of care, and, while CPOE systems have been shown to markedly decrease prescribing errors, this can largely be ascribed to their ability to standardize drug doses, provide decision support, and eliminate errors from poor handwriting or incorrect transcriptions.”

As such, clinicians “generally override the vast majority of CPOE warnings, even ‘critical’ alerts that warn of potentially severe harm,” according to AHRQ. Meanwhile, “alert fatigue increases with growing exposure to alerts and heavier use of CPOE systems. This finding is intuitive, but also raises the important implication that without system redesign, the safety consequences of alert fatigue will likely become more serious over time.”

At The University of Vermont Medical Center, clinicians have been using a new CDS technology to customize their EHRs, tailoring type and number of interaction alerts to a more manageable level.

“We transitioned from a homegrown EHR system five or six years ago,” says Larry Lamb, clinical application analyst in the pharmacy at UVMC. In that self-developed system, “we built all the interactions tables so we had total control of how many interactions were firing,” he says.

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