Doctors are master multi-taskers — but electronic health records (EHRs) have not helped simplify things.
When a physician sits down with a patient to talk, the doctor now has to take notes on a computer, engage the patient, ask the appropriate questions, listen to the responses — and document it, all at the same time.
“In a physician’s life it’s definitely an annoyance, but it could be a very dangerous annoyance,” one physician warned.
What patients don’t see are all the notifications that pop up as doctors go along, which can cause “alert fatigue.”
When doctors are bombarded with these notifications, it can cause more stress for them. That constant state of alert, while they’re struggling to pay attention to it all, could have a negative impact on their health and ours.
Checking the Wrong Box?
Imagine if a doctor, in a state of frustration from all these signals, clicks off one of them about a severe medication interaction. Or perhaps the doctor forgets to record something vital, or checks the wrong box. In the field of medicine, small mistakes can have huge consequences.
Dr. Shobha Phansalkar, an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston, has studied informatics and clinical quality control extensively. She said smartphones and EHRs can give physicians an advantage — but alert fatigue is just one of the unintended consequences.
Doctors are encouraged to interact with patients during visits; the EHR system prompts them to ask questions. As they gather answers, alerts pop up. If a doctor decides to put a patient on a medication, for example, a notification details possible interactions. Reminders also pop up for other reminders, such as applicable laboratory tests, pharmacy regulations, and notices about best practices.
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“There’s a whole plethora of things happening when the physician is sitting with the patient,” Phansalkar said. The alerts can be disruptive because doctors are trying to carry on a conversation and listen well. They want to focus on the relationship with their patients, but may not do as well due to all of the interruptions.
“As the adoption of EHR increases, there’s definitely more alert fatigue,” she said.
The effects of this fatigue on doctors are similar to when the rest of us see pop-ups on our phones and laptops. Our brains get desensitized to it over time — and it becomes an irritation.
“In a physician’s life it’s definitely an annoyance, but it could be a very dangerous annoyance,” Phansalkar warned.
Dr. Mike Sevilla, a family physician from Salem, Ohio, said he often hears from colleagues that alert fatigue is another frustrating part of the job. Alerts also come up when different EHR platforms do not sync, creating an unnecessary signal that can divert attention away from patient care.
Resolving the Issue
In Phansalkar’s experience, EHR alerts can be useful — when needed. If EHRs could better tailor the notifications that come up, reducing them to those only critically necessary and applicable to a patient’s needs, it could decrease alert fatigue.
She said dialogue has opened with EHR software manufacturers to try to build systems that more closely correlate alerts that doctors need to see, or are customized to patient needs. For instance, a possible prescription medication interaction notice may not be needed, if the patient isn’t on that prescription.
The EHR has to be able to adapt to the content, Phansalkar said. “This is where we are lacking. Unless that bridge is built, this problem is not going to get solved.”
Fatigue can also have a stronger impact depending on how the alert is displayed, or if it requires the user to click something to make the alert disappear. “Those design principles also drive the annoyance that physicians face,” she explained.
Phansalkar said health systems and EHR manufacturers must cooperate to create systems that are intuitive and developed to lower alert fatigue, instead of just creating systems so medical facilities can comply with EHR regulations.
“Software has to take into account human behavior,” she said.