Another consequence of poorly designed electronic medical records (EMRs) is "
alert fatigue":
Electronic health records increasingly include automated alert
systems pegged to patients’ health information. One alert might signal
that a drug being prescribed could interact badly with other
medications. Another might advise the pharmacist about a patient’s drug
allergy. But they could also simply note each time that a patient is
prescribed painkillers — useful to detect addiction but irrelevant if,
say, someone had a major surgery and is expected to need such meds. Or
they may highlight a potential health consequence relevant to an elderly
woman, although the patient at hand is a 20-something man.
The number of these pop-up messages has become unmanageable, doctors
and IT experts say, reflecting what many experts call excessive caution,
and now they are overwhelming practitioners.
Clinicians ignore safety notifications between 49 percent and 96
percent of the time, said Shobha Phansalkar, an assistant professor of
medicine at Harvard Medical School.
“When providers are bombarded with warnings, they will predictably
miss important things,” said David Bates, senior vice president at
Brigham and Women’s Hospital in Boston.
This can have real-life consequences:
In one instance at Children’s [Hospital of Philadelphia], doctors ignored relevant information
about how a patient might respond to a drug, Shelov said, because it
appeared alongside heaps of other superfluous notifications — warnings,
for instance, about drugs that posed minimal risk of interfering with
each other. Consequently, the patient received medication that induced a
potentially lethal reaction.
The hospital caught the mistake in time, but the incident spurred a
series of changes. A team of pharmacists, doctors and other clinicians
have sorted through what triggered alerts in their system, turning off
the ones they decided weren’t actually relevant or necessary. That has
helped. But it’s still an ongoing battle, Shelov said. “It’s a little
bit of trying to turn off the firehose.”
When everything is "critical", then nothing is.
