Chandresh Shah

EHR Alert Fatigue – Solution: Workflow

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So much as been written about EHR Alert Fatigue. Here is how HealthcareITnews defines it:

Alert fatigue arises when so many different systems – from mobile phones to medical devices to electronic health records – give prompts, alerts or alarms that physicians no longer pay attention to them. Likened to a digital version of “the boy who cried wolf,” the condition is a concern because many of the alerts are designed to prevent error but doctors disregard them and instead rely on their own judgments. Some studies show doctors disregard more than 90 percent of the drug interaction alerts and 77 percent of the drug allergy alerts.
— Healthcare IT News

I was speaking with an experienced EHR user – a Physician that has used a system for many years and is now looking to replace it. Her question was, ‘Can  system automatically assign a task to my nurse when I order Radiology?’ I asked her to elaborate what she meant and why. She wanted to have the ability to Track how many x-rays were ordered, how many are done, how many are pending and how long? She wanted to have someone followup with patients if those orders are not done and/or results have not come in.

Is Tasking of Orders the right answer?

System usability experts will tell you tasking is not a bad idea, but even worse is creating alerts. Here is what says about “Responding to Alert Fatigue“. Alerts related to physician decision support systems is one thing, alerts related to employee tasks and responsibilities is another. ‘Interruptive decision support alerts can be a major source of user frustration and system inefficiency. Careful consideration should be given to the type and frequency of alerts that are included in decision support systems’. 

Workflow Responsibility is a better approach

I have seen efficient practices where creation of a sound and efficient workflow is a better approach. For our daily routine tasks and responsibilities, we don’t have ‘alerts’ or smartphones reminders, because of the fact that they are routine. I don’t need an alert to remind me to brush my teeth. In a medical practice, you have staff checking your fax machine. You don’t need a task or an alert to remind someone. Checking Fax is someone’s responsibility and they do it periodically. Where is the check? At the end of the day or twice a day, if you see paper lying on the fax machine, you know someone has not done their job.

Similarly, when a system has a queue or report that helps look at pending orders, completed orders etc. in a well designed system workflow, you don’t need tasks and alerts. It will unnecessarily increase clicks and time required to manage them. Anyone can go to this queue to see if the responsible person is doing their job.

Solution: Efficient Process and Workflow

In summary, it is better to have an efficient workflow and documented processes in place than have computer systems ‘regulate’ with tasks and alerts. Having said that, it is also imperative that there be checks and balances to monitor the workflow.