Charles A. Pilcher MD FACEP
March/April, 2013
One third of physicians surveyed admit to missing a test result because of information overload linked to their Electronic Health Record (EHR).
It’s called “Alert Fatigue,” and it’s a growing challenge. Most EHRs have built in alerts, designed to keep physicians from making mistakes: Examples:
- “Patient due for repeat mammogram in 4 weeks.”
- “Cephalexin prescribed. Allergy to penicillin. Click ‘override’ to continue.”
- “Last Percocet prescription yesterday. Do you wish to proceed with refill?”
- “The dose prescribed is out of range for a 2 year old.”
- “Critical value: Potassium 1.5”
- “Please see biopsy report.”
- “Telephone call from patient. Abdominal pain worse.”
In a survey by Singh et al published in JAMA Internal Medicine of 2600 Veterans Administration primary care physicians:
- 55.6% reported that their EHR made it possible for practitioners to miss test results.
- 69.6% reported receiving more alerts than they could handle
- 86.9% perceived the quantity of alerts they received to be excessive,
Most important, 29.8% reported having missed results that led to delays in care.
The median number of alerts PCPs reported receiving each day was 63.
The net result makes one wonder, “Is an EHR worth it?”
EHRs are supposed to increase patient safety, improve quality, and make physicians more efficient. However, in a 2012 study by Medical Economics, productivity declined an average of 30% during the implementation period, was as high as 50% in some, and arguably may never produce the efficiencies touted by consultants, vendors, and the government.
And with the metadata provided by computer audit trails available for most EHRs, it should be easy to show who saw an alert, and when. Or who did not see it?