VA, Regenstrief Study Tackles Alert Fatigue

April 11, 2013
A study by researchers from the Indianapolis-based Regenstrief Institute and U.S. Department of Veterans Affairs provides a look at how health care providers react to medication alerts generated by electronic medical record systems and addresses the growing issue of alert fatigue. The researchers concluded that clinical alerts need to be more useful and usable for physicians in order to avoid desensitization.

A study by researchers from the Indianapolis-based Regenstrief Institute and U.S. Department of Veterans Affairs provides a look at how health care providers react to medication alerts generated by electronic medical record systems and addresses the growing issue of alert fatigue. The researchers concluded that clinical alerts need to be more useful and usable for physicians in order to avoid desensitization.

The researchers observed providers as they treated patients to learn about the strengths and weaknesses of medication alerts for the study. They found the most common medication alerts are warnings about patient allergies, drug interactions and duplicate prescriptions. The alerts, critical to patient safety, they say, can be triggered by many factors including the prescription of a new medication or a change in a patient's laboratory test results. Too many alerts, the researchers, can lead to alert fatigue.

"As a human factors research scientist, I am interested in learning how to improve the usability of electronic medical records systems so doctors, nurses and pharmacists can work more effectively. I also am interested in finding ways to make health care delivery safer for patients," Alissa Russ, Ph.D., a research scientist with the Center of Excellence on Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center in Indianapolis, and co-author of the study, said in a statement.

The researchers looked at 320 medication alerts generated by an electronic medical record system, which was looked at by 30 doctors, nurse practitioners and pharmacists who treated 146 patients in a variety of outpatient clinics. The authors identified nine factors that influence prescribers as they encounter alerts, providing a detailed description of 44 components that contribute to these factors. Uncertainty, pharmacy-designed alerts were a few reasons why practitioners ignored alerts.

"Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems," Dr. Russ said. "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."

The study, "Prescribers' Interactions With Medication Alerts at the Point of Prescribing: A Multi-Method, In Situ Investigation of the Human-Computer Interaction" appears in the April 2012 issue of the International Journal of Medical Informatics.

For more on alert fatigue, check out this feature from HCI Assistant Editor in this month’s issue.

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