EMR Alert Fatigue Can Have Deadly Consequences

Posted on May 31, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A case study published this week in the journal Pediatrics suggests that EMR alert fatigue is becoming a major source of potential medical errors.  According to a piece in iHealthBeat, “a deluge of repetitive, inappropriate alerts” have been generated by EMRs of late, causing clinicians to ignore or override alerts very frequently.

Problems with alerting in medication order entry systems are proving to be a particularly serious safety hazard, it seems.  “It has been well established that clinicians override many drug allergy alerts generated by the electronic health record,” write the authors of the Pediatrics study.

The case study in Pediatrics comes from researchers at Stanford University Biomedical Informatics and Harvard Medical School.  Researchers examined the case of a two-year-old boy who died after clinical staff overrode scores of distracting EMR alerts — more than 100 over the course of one month — and ended up inappropriately administering a diuretic to the patient.

The key to addressing this  problem appears to be zeroing in on approaches to minimize the number of non-evidence based alerts that bedevil physicians during their time with patients. However, implementing these changes can be very complex.

In the PICU researchers were observing for their study, the facility made evidence-based allergy alerting alerts to the hospital’s system. However, that’s just one aspect of a multifaceted problem.  As the authors note, “incorporating clinical evidence in electronic drug allergy alerting systems remains challenging, especially in pediatric settings.”

But given that pediatric patients usually can’t themselves alert doctors or nurses when the wrong drug comes to hand, this seems like it should be a priority when looking at ways to reduce EMR alert fatigue.