Overabundance of medication alerts too detailed to help busy docs

Too many medication alerts exist in electronic health records, and often times those alerts contain warnings that are too detailed to help busy clinicians, according to a new study by Indianapolis' Regenstrief Institute and the U.S. Department of Veterans Affairs (VA). The institute calls the study first "in-depth look" at how physicians react to such alerts in EHRs.

Researchers followed 30 doctors, nurse practitioners and pharmacists as they treated 146 patients in outpatient clinics and received 320 medication alerts, including warnings about patient allergies, drug interactions and duplicate prescriptions. They observed and analyzed factors that contributed to how clinicians responded to the alerts.

Their paper, published in the International Journal of Medical Informatics, notes that prescribers were sometimes unsure of why an alert was appearing. The prompts seemed to be more oriented to pharmacists than doctors or nurses, despite the fact that the latter were the alerts' main recipients.

"Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems," co-author Alissa Russ said in an announcement. Russ is a research scientist with the Center of Excellence on Implementing Evidence-Based Practice at Indianapolis' Richard L. Roudebush VA Medical Center.

"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," she added.

In many organizations, alert fatigue may be even more pronounced than it was in the presence of the Regenstrief researchers. According to one study published in the Journal of the American Medical Informatics Association, "physicians in various care settings override or ignore 49 to 96 percent of all alerts." Another study, published in Health Affairs, points out that EHR vendors purposely maximize the number of alerts in their products--and make it difficult for providers to adjust those alerts--in order to reduce their exposure to liability suits.

The authors of the latter paper, who believe these liability concerns are overblown, suggest that alerts be tailored to particular care settings or specialties, or the characteristics of individual patients. Physicians would be less likely to ignore the tailored alerts, they contend, because the warnings would seem more relevant to them.

To learn more:
- read the announcement about the study
- here's the study's abstract in the International Journal of Medical Informatics
- read the study on alert fatigue
- check out the paper on tailored alerts

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