Clinical information systems now produce great quantities of data. That can be both blessing and curse.
Perhaps no one knows this better than physicians, who are looking for help in separating important information from that which is not. Systems that can’t help them with that process can impede their ability to provide effective care.
Alert notifications have been often cited as culprits in this gush of information. Intended to let physicians know when patient conditions merit their attention, the ability of systems to crank out alerts at a dizzying pace has had the opposite effect, at times.
This is not a surprise to anyone who’s been in the industry for a while. However, sadly, results of a recently completed study supplies more evidence that alert fatigue hasn’t been addressed.
The study, published in the most recent issue of the Journal of the American Medical Association for Internal Medicine, found that physicians in the research sample received an average of 77 notifications per day.
Previous studies suggest that physicians spend a little less than a minute reading and reacting to each notification, so authors of the most recent study estimated that physicians in the study spend about 70 minutes a day processing notifications.
While some of the notifications are important, others are not and just arrive as part of a “For Your Information” service. That inability to help physicians triage incoming messages from commercial EHR systems can be a source of inefficiency.
“Because a single notification often contains multiple data points (for example, results of metabolic panels contain seven to 14 laboratory values), the actual burden and cognitive effort required of the physician is likely greater,” the study’s authors say.
Results get back to what everyone thought EHR systems would be able to do in the first place, according to the study. “Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information is needed.”
Perhaps most demoralizing is when this study was conducted—it involved the review of electronic logs of all notifications received by all physicians from January 1 through June 30 last year at three large practices in Texas. That’s last year, people. And how long have we been discussing concerns about alert fatigue and the burden of clinicians’ managing information?
We’re not all physicians, but we all know very well what this must be like, just from the flood of email that most of us receive. Many of us receive dozens, if not hundreds, in a day, and it creates significant cognitive interruptions to our ability to do the work in front of us. We work in fits and starts, and we are sometimes amazed at how we accomplish anything during a day.
Physicians are at an entirely different level in terms of all the information coming in from multiple patients, multiple settings, multiple levels of crisis, at all hours of the day, much of it interrupting thought patterns from the patient right in front of them.
If the average number of interruptions is 77 per physician, and they’re working a 12-hour day, that’s one alert coming in every nine minutes or so. While we all want important, critical alerts reaching physicians when it’s crucial, there must be a way to manage this better.
In a recent interview with the CMIO of the American Medical Association, Michael Hodgkins, MD, he discussed the impact of physician struggles with technology. EHRs, he contends, are an important contributor to physician burnout—not the only reason “but they are an important factor.” The AMA is getting more involved in IT because “no one wants to repeat the mistakes in the past, and technology in the past was not driven by physicians. We haven’t been engaged enough in the development of these tools.”
Making progress on alert fatigue—after so many years of knowing about the problem and its effects—would be a fitting first step.
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