Study: Clinical Trial Alerts in EHRs Have Limitations

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Physicians using electronic health records that give alerts about appropriate clinical trials experience alert fatigue but rates of response remain relatively high, according to a new study. Still, overall results are mixed.

Researchers for 36 weeks documented the response patterns of 178 physicians receiving alerts for an ongoing clinical trial, collecting data on response rates to the alert and patient referral rates. Response rates declined over time, but even after 36 weeks remained in the 30 to 40 percent range, concludes the study.

The study occurred in three provider environments using the ambulatory Centricity EMR of GE Healthcare. Response rates to alerts initially hit about 50 percent but dropped by 2.7 percent in each advancing two-week period, then stabilized. “Notably, there was still a 35 percent response rate at the 36th week of exposure,” according to study authors. The response rate drop-off was greater among community-based physicians than those based at universities.

Trial referral rates started at about 33 percent and fell to 9 percent by the end of the study. “While the fall in response rate suggests alert fatigue over time, the fact that a substantial proportion of the alerts were still being responded to at 36 weeks suggests that such a duration of use may still provide benefit,” study authors suggest. “However, the finding that referral rates declined more quickly and more precipitously over time than response rates suggests there might be a point after which use of a CTA (clinical trial alert) might not be worth even the minimal disruption they cause.”

The authors suggest that future CTA deployments be tailored to a particular setting, such as shorter periods in community settings and longer periods at universities to maximize benefit while avoiding excess fatigue. The study, “FOCUS on clinical research informatics: Evaluating alert fatigue over time to EHR-based clinical trial alerts: findings from a randomized controlled study,” is available in the June 2012 issue of the Journal of the American Medical Informatics Association.


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