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87% of Physicians Say Quantity of EHR Alerts 'Excessive'

 |  By Chelsea Rice  
   March 05, 2013

Electronic health records systems are the latest source of information overload.

Nearly one-third of physicians miss electronic notifications of test results in electronic health record systems, according to a research letter published this week in JAMA.

Of the 2,590 primary care providers surveyed in the Department of Veterans Affairs by the researchers, 86.9% perceived the quantity of EHR alerts to be excessive, and 69.6% said they received more alerts than they could effectively manage. More than half (55%) of surveyed physicians said current EHR systems made it possible to miss the alerts.

"What stood out was information overload and the easier the systems were to use, you tended to miss [fewer] test results." said Hardeep Singh, MD, MPH, the study's lead author, from the Houston VA Health Services Research and Development Center of Excellence.

Singh's earlier research on this topic was published in the Journal for Patient Safety in 2010, where he argued for integrating alert notification systems within electronic health records to help physicians avoid missing abnormal test results in diagnostic procedures.

Today, the issue has shifted. Physicians are missing test results, not because of their volume, although that is a factor, but because of how the systems display data, says Singh. EHR systems typically pile test results alongside notes from colleagues and other communication.

"I would say that it is a similar problem to alarm fatigue where you tend to get desensitized because there are too many alarms going off at once, so in the same way, you tend to get desensitized because there's too many alerts to receive," says Singh.  

"With regard to patient safety, I think this is in the context of missed test results, so the impact may not be the same as someone who may have arrhythmia of the heart and you need to react right away, but the long-term effects of not responding to alerts could lead to eventual patient harm."

The study looked at physicians who were receiving many types of notifications and not just test result notifications, the combination of which Singh says is the main contributor to the information overload physicians are experiencing.

"It wasn't a pure relationship with a number," says Singh. "So it wasn't that physicians who received 100 notes a day were all missing notes or alerts, and people who were receiving less weren't missing alerts or notes. The results were based on the construction of the alerts and the system."

Singh points to workflow, people, and organizational policies and procedures as reasons for hospital and health system administration to pay attention to their systems that leave their physicians vulnerable to information overload, and their patients vulnerable to that missed information.

"Organizations can determine your workflow very strongly. So in the parent survey, we realized that only about 30% of providers were getting some type of workflow support in terms of tying in workflow processes, so if you don't have the time needed to process these alerts, then that's a problem. Because you have lots of information coming from so many different members of the system, and they are all important."

"One thing that stood out were electronic hand-offs, which occurred with doctors going on vacation for a few weeks and trying to transfer the alerts to their covering doctors, but not knowing how. So what we realized were these handoffs of care, the covering practitioners could not ever be receiving the messages or alerts either," says Singh.

"For hospital executives and health leaders, it's really important for them to know that it's time to develop a measurement system for these types of things, to understand how much these lost bits of information are affecting things,"  Singh said.

Chelsea Rice is an associate editor for HealthLeaders Media.

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