Health systems are continually focused on producing measurable improvements in patient health outcomes. The use of electronic health record (EHR) alerts, which deliver real-time, actionable recommendations and warnings to clinicians specific to each patient, are intended to increase provider efficiency and level up the quality of care delivered to a patient.
However, EHR alerts may also have a negative impact on clinicians. Studies cite the risks of alert fatigue and burnout on clinicians. Health systems trying to find the right balance of quantity and quality of alerts may turn to technology and data to help optimize their systems.
Benefits of EHR alerts
EHR alerts can help reduce instances of potential drug interactions, save the patient from unnecessary testing, and advise clinicians on the next best course of action for patients facing their specific health condition.
Alerts can generally fall into two major categories: drug-based alerting (e.g., drug-allergy, drug-disease, drug-drug, etc.) and non-drug alerting.
Drug-based EHR alerts warn clinicians about risks related to ordering a medication and its potential impact on a patient based on characteristics like an allergy or something in the patient’s medical history. Non-drug alerts help providers make decisions about lab orders and suggested screenings, as well as any other operational tasks that should be considered for the patient based on the contents of their health record.
Too much of a good thing?
EHR alerts have their rightful place in the healthcare system and can provide lifesaving advice when minutes matter. However, the clinical community has been raising their hands for years over interruptive alerts - those that require a user to interact with a visual cue for a recommended next action. Providers say they’re often overburdened by the sheer number of alerts they receive, as the forced action requiring them to acknowledge the alert can impede the clinical workflow. Plus, clinicians claim many of these alerts are redundant, unhelpful, or otherwise unnecessary. This information overload leads to alert fatigue, which is just one of several risk factors for clinician burnout.
When systems are designed well and alerts are firing at the right, most helpful time, EHR alerts can enhance the quality of care. But when those alerts become burdensome to the clinician, the entire health system suffers - namely, the patient for whom the alerts were intended.
Providers feeling overburdened by the sheer number of alerts may ignore even the most urgent of them, putting the patient at risk with subpar care and potentially increasing their risk of an adverse outcome, including death.
How technology can help
EHR alerts are only as good as the systems behind them. To reduce the risks of alert fatigue and clinician burnout, it’s worth reviewing the data behind those alerts and initiating process improvements to help clinicians and patients alike.
Where to start? Clinical informatics offers a path to eliminate frustration around alert fatigue and clinician burnout. At Phrase Health, we partner with informaticists, quality improvement (QI) and patient safety teams, health IT organizations, and hospital administrators to understand the story behind your data. But no matter which informatics platform you choose, consider the following to reduce alert fatigue:
- Review your organization’s goals: Is your goal to reduce the volume of EHR alerts, or to promote better patient outcomes; maybe a combination? Knowing your goals allows you and your quality and informatics teams to define the metrics most important to your organization.
- Analyze the data: It may sound simple, but there’s a world of information behind alerting data. Where to start?
- Review alert overrides for any common themes. Are clinicians overriding alerts for common conditions (e.g., sepsis, pneumonia, VTE)? Are those alerts drug-based or non-drug alerts?
- Look at a measure of burden (e.g., the Phrase Burden Index). What do the numbers show, and how does it align with alerts, including overrides?
- Check into the percentage of alerts with duplicative information. Are these the alerts that are being overridden? How often do these alerts fire per day?
- Read the comments. If your alerting system allows for clinicians to provide feedback in the way of open-ended comments on alert firings, dig into the data. Are you noticing particular themes and/or frustrations? Consider implementing a “cranky comments” heuristic to notify you when specific alerts are malfunctioning.
- Iterate and improve: After you’ve analyzed the data, make an improvement plan. You might consider whether to prioritize certain alerts, consolidate others, modify who’s getting which alerts, and so on. Tying your plan back to your organization’s overall goals, while considering clinician feedback and patient outcomes, is imperative. A common quality improvement methodology for tackling iterative improvements is through adoption of PDSA (Plan-Do-Study-Act) cycles.
- Test, measure, repeat: When it comes to improving patient outcomes, there’s no endpoint - every organization will need to keep an eye on its data and QI measures in order to inform future decisions. What’s working (or not working) now may provide clues into quality improvement, but as best practice guidelines and validated scientific research evolves, so too will EHR alerting.
