EMR / EHR Alerts and Crying Wolf
An article published on March 4, 2013 in MedPage Today quotes a study done among doctors in the VA’s health system, and led by Dr. Hardeep Singh that says 30% of doctors had failed to notice important test results that were sent to them via EMR alerts. The study’s authors claimed that the overload of alerts from EHRs caused doctors to disregard real alert messages.
In an earlier study of EMR use at the same Houson VA center, doctors said they were more likely to follow up on imaging results when they received phone calls from radiologists in addition to receiving the EMR alert.
Many doctors and nurses who use EMRs say they suffer from “alert fatigue” regarding medication contra-indications because EMR alerts are so common that they become unhelpful “noise” to doctors, rather than indicators of problems.
These distressing results tell us two things: EMR’s need a more sensitive alert system that has a “code blue” type of indicator to denote serious alerts and separate them from less important alerts; and sometimes humans still have to intervene as humans to flag a serious problem because we respond more seriously to a human voice than a text message.
These issues make us all wonder whether EMRs are truly able to improve the quality of care for patients. And the answer, to be honest, is always going to be the same: “maybe.” Because, as always, the tool is only as good as the craftsmen who use it. And sometimes, the overkill offered by the over sensitive tool causes a good doctor to ignore its persistent yammering.
If you are assessing a new EMR, talk to the vendors and reps about this problem. Ask them how sensitive their alert system is, and how it can raise the bar on sensitivities. Is there a way to indicate a serious problem and separate it from a non-serious problem? Is there a way on their system to flag the difference?
We realize that we are asking EMR’s to be smart, but EMRs are becoming more intelligent on a daily basis, and when you are considering a major EMR purchase or leasing agreement, you have a right to look for the best and the smartest system so that you and your patients do not become victims of an EMR crying wolf.