E-prescribing alerts often 'too much, too late' for docs

Computerized prescribing alerts were 'too much, too late' in a study that found only 2 percent prompted any action from physicians during patient visits.

In the study, published this month in the Journal of the American Medical Informatics Association, University of Edinburgh researchers videotaped eight physicians as they electronically wrote 132 prescriptions. They found that during most doctor-patient interactions, more than half the discussion of a medical problem had already taken place before the doc turned to the computer. What's more, alerts appeared after the physician had explained the options, selected a treatment with the patient, and at times after instructing the patient on how to take the medication and printing out instructions.

"An alert in the final seconds of the task of generating the paper prescription is likely to be regarded as intrusive and unwelcome, and increases the probability of it being ignored," the authors said.

Alerts must appear to the physician much earlier in the process, the researchers added.

Tony Avery, professor of primary care at the University of Nottingham who was not involved in the study, told Pulse that while the software used in the study was "very basic," and that newer software likely will help to eliminate some of the problems encountered, process adjustments need to be made on the parts of physicians, as well.

"You only need to talk generally with the patient about their condition," Avery said. "[Y]ou can then go to the computer and make your decision--and only commit yourself and tell the patient once you have decided what you are going to give them."

Nearly half of all U.S. physicians use e-prescribing features in an electronic health record, according to the latest count from the Office of the National Coordinator for Health IT.

Still, a small study published last year in the Journal of the American Board of Family Medicine found physicians leery of e-prescribing, due to unreliable formulary and benefit information and medication history.

Too many alerts and too much information provided with those alerts make clinicians prone to ignore them, according to published last year by Indianapolis' Regenstrief Institute and the U.S. Department of Veterans Affairs. Too often, they were more oriented to pharmacists than the doctors or nurses receiving them.

"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," co-author Alissa Russ said of the latter mentioned study.

To learn more:
- here's the abstract
- check out the Pulse article

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