How clinician alert systems need to become smarter

Creating IT platforms that inform—and don’t intrude and cause fatigue—can help medical pros better respond to patients’ medical situations.

Electronic medical records systems are causing a lot of challenges for clinicians. Of all the issues with usability, data quality, communication and more, one of the biggest challenges with the systems is alert fatigue, and the complaints have merit.

The number of alerts constantly interrupting workflow, although intended to be helpful, are on the rise as technologists abuse the ability to fit more messages on a screen. This precious real estate is being devalued, as alerts are ignored, studies show. This is obviously not what health IT envisioned for the system, and as physician burnout reaches an all-time high, it is a pressing problem technologists must solve.

The solution lies in giving clinicians more control over their workspace—that can reduce the burden of the system on the user to make it more useful, applicable to them personally, and insightful about a patient—possibly even more pleasant to have to use in the first place. Consider the smartphone and how it’s used by millions as their workspace every day. Users control the apps that are installed on their phones, where they are placed on the screen and the alerts that are received.

This design philosophy has proven successful in the implementation of technologies or alerts that give clinicians cost and risk data within the EMR through a designated portion of screen real estate that they choose to engage with or not. Instead of the EMR being designed and given to them with complicated customization options, there are a few key takeaways from this philosophy for health IT and the EMR industry.

To start, the aviation and healthcare industries are often compared, and in looking at this particular challenge, aviation can lend some insight. The cockpit of the 1980s was complicated with hundreds of buttons and flashing alert systems. Step into the cockpit today, and technology has been streamlined to provide only the most important, most necessary alerts to pilots, and have been designed with them and the situations they encounter in mind.

User experience, including how the technology impacts workflow, has been largely ignored in the designing of the EMR. Improving alert fatigue requires alerts to be relevant and actionable, with a low level of engagement needed to interact with them. New forms of alert systems offer advice on cost and risk, and are designed to be unobtrusively educational by having context in that speciality, to that patient and more. Such approaches leave it to the provider to decide what is most appropriate in any situation, but the key is enabling them to make informed value judgments with the alerts—requiring little action with the alerts to do so.

User feedback is commonplace in the technology world, but not in the case of the EMR. The health IT providers that open up the feedback loop from clinicians have a huge opportunity to improve. Feedback can be used to help customize the experience for that particular doctor or user.

Consider Pandora and how the application learns what a user does and does not want to hear through simple “thumbs up” and “thumbs down” opportunities. An alert or feature that is relevant for one clinician may not be as applicable to another. Creating this feedback algorithm for any health IT technology could be crucial in driving value and adoption.

The EMR is supposed to be the crux of the health IT system and the technology central to value-based care. EMR providers are consistently criticized for being difficult to integrate with. Hundreds of third-party integrations exist with technical footprints that range in size. Ideally, these integrations make the EMR more valuable, but there is still much work to be done to push EMR providers and other health IT technologies to work together to do what the system intended - centralize health data to increase access to and gather meaningful insights from a person’s health history and information.

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