Posted by: AllinHIT
EHR, EHR alerts, EHR functionality, EMR
On April 3, 2012 the Richard L. Roudebush VA Medical Center in Indianapolis released a survey revealing that EHR medication alerts cause physicians to get “alert fatigue”. The main cause for this “fatigue” is the nature of there being too many, providing too much, non-relevant details, and the alert not pertaining to the specific patient, but instead to their condition.
After reading the high points of the survey, I thought back to when I was selling a stand-alone eRx application, and the lack of system parameters pertaining to alerts. I thought about the different alerts one can receive, besides medication alerts, and how those can/should be handled so they are relevant during the point of care. Then, I thought about my experience with Epic, and its capability with “Best Practice Advisory alerts”, and the process of overriding any system alerts. I then came to the conclusion that EHRs are not equal when it comes to having flexible EHR parameters, driving the functionality of alerts. Let me explain what I mean.
When it comes to medication alerts, EHR system parameters — part of the building process) — should have an area where one can set their own individual alert parameters, based upon user ID. Within those “alert parameters” should be various “alert severity levels that they can accept or not accept. I could be a physician that only wants to see alerts with the “highest of severity”, hence reducing the number of low or moderate alerts. Additionally, the alert severity should be applied separately to each type of alert (medication, best practice, out -of range lab results, etc.). Alerts and severity levels should have an alert hierarchy (system, department, individual) with one overriding the other, ending with individual alert settings.
In addition, physicians must be able to setup patient specific alerts and be able to override them based on alerts generated by the system within the parameters. This will allow for the physician to override system alerts one time, avoiding constant overrides for a condition specific to the patient. For example, if I know that an out of range blood pressure is normal for my patient, I can go into the “alert parameters” and have the alert ignored for this patient.
This is the type of flexibility that EHR vendors must consider when designing their system. Giving physicians the ability to avoid un-necessary alerts, will encourage physicians to really pay attention to the alerts, knowing that they are not getting alerts that waste their time. Some EHR’s have these capabilities, others don’t. I say choose wisely because alerts can hurt when they are constantly interrupting the delivery of care!