Health care IT (HIT) as an industry is focused on delivering intelligent solutions to providers, pharmacists and payers in an effort to further improve patient outcomes and care. At CoverMyMeds, we strive to remain cognizant of what is top-of-mind for health care workers and to anticipate future needs, so we can adapt our solutions in response. In this article, we will consider the growing concern of alert fatigue for providers and pharmacists that is damaging job satisfaction and potentially compromising patient safety.
American health care is continuously transformed by technological breakthroughs out of the HIT sector. Notable developments over the past few decades include electronic health records (EHRs) to consolidate and simplify patient medical history, electronic prior authorization (ePA) to streamline the burdensome prior authorization (PA) process and various solutions for driving patient-specific care driven by scientific advancements like pharmacogenomics and personalized medicine. These technologies are designed with the best of intentions to streamline provider workflow, reduce administrative inefficiencies or secure patient safety, and normally deliver on what they promise; nevertheless, well-meaning technologies can have detrimental, unforeseen consequences for the end user.
Few examples of “good technology, gone bad” are as striking and high-stakes as the alerts functionality integrated into pharmacy software and EHRs through computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Designed to prevent adverse drug events from erroneous prescription of medications, such alerts can have positive effects on patient safety and quality of care. In fact, application of CPOE and CDS into clinical practice was shown to reduce non-missed-dose medication errors (i.e. medication not available for administration) and non-intercepted serious medication errors (i.e. incorrect medication reached the patient) by 81 and 86 percent, respectively, in a hospital setting.1
The initial success of such alert initiatives prompted the inclusion of additional alerts within the EHR to signal for drug allergy contraindications, basic dosing guidance, formulary decision support, duplicate therapy, drug-to-drug interactions and many other situations.2 Unfortunately, this has led to the inclusion of low-priority notifications that providers must also acknowledge. Recent studies have reported that providers spend over an hour a day sifting through nearly 80 notifications and alerts from their EHRs.3 To help put this in perspective, another study found that on average providers received 49 alerts for every 100 medications they prescribed.4
While this decreasing signal-to-noise ratio for alerts may not overtly seem like a problem, it has led to the unexpected trend of providers and pharmacists overriding many alerts that pop-up on their screens. Although most of these overrides are based in sound clinical judgement, the sheer volume of alerts compels that some are oversights, and this is the crux of alert fatigue. It is estimated that up to 90 percent of alerts are overridden and >75 percent of the time the override is inappapropriate.5,6
With so many alerts bombarding the pharmacists and providers, important alerts can get accidentally dismissed. As an example, this June, a provider and pharmacist in Massachusetts missed an alert indicating that a patient was severely allergic to a prescribed pain reliever and the patient nearly died from the reaction.7 Beyond the risk to patients and legal ramifications caused by alert fatigue, providers feel overwhelmed by EHR alerts to the point that they may quit their jobs, as indicated by a study correlating such alerts with job satisfaction.8 Too many alerts create the potential for important clinical information to slip through the cracks and add unnecessary stress to users. Accordingly, careful user testing to identify and prioritize those alerts that get acknowledged by providers and pharmacists will help prevent unfortunate adverse drug events in future.
It is abundantly clear that alert fatigue is top-of-mind for providers and pharmacists. As leaders in HIT, we are responsible for ensuring that our technological developments only help those intended. For this reason, any CoverMyMeds solution is developed in close collaboration with those stakeholders that will use it on a regular basis. Solutions like RxBenefit Clarity™; and ClinicalAlertsPlus™; are designed with providers and pharmacists in mind to supply a user experience that streamlines workflow and helps deliver only actionable alerts for enhancing patient care. As the industry steams forward, it will be ever more important to consider the best interests of stakeholders for providing authentic HIT solutions that promote interoperability and make life easier.
- The Impact of Computerized Physician Order Entry on Medication Error Prevention
- Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems
- The Burden of Inbox Notifications in Commercial Electronic Health Records
- Alert Fatigue is an Alarming Problem, Optimum Healthcare IT
- Overrides of Medication Alerts in Ambulatory Care
- Medication-Related Clinical Decision Support Alert Overrides in Inpatients
- Alert Fatigue a Focus After Patient’s Drug Allergy Warning Missed, Healthcare Dive
- Electronic Alerts and Clinician Turnover: The Influence of User Acceptance