HR alerts and reminders, when used properly, offer clinicians a “safety net” whose function serves to mitigate patient risk and optimize the quality of care.
EHR alerts and reminders, when used properly, offer clinicians a “safety net” whose function serves to mitigate patient risk and optimize the quality of care. Given that alerts have been a standard feature in EHR software for well over a decade, researchers have had ample opportunities to examine their efficacy (or lack thereof). For the sake of clarity definitions used by Perri-Moore, 2015 will be used. Alerts refer to “a notice or communications to warn patients of potential harm, problem, or danger with the intention to take action to avoid or address the threat,” whereas reminders are “a communication or message to ensure patients remember something, such as an appointment.”
Primarily, the research regarding EHR alerts and reminders center on their role in care management with a substantial amount of work focusing on clinical decision support (CDS). Another vein of research on EHR alerts examines the role of alerts in improving patient population health. Lastly, in recent years researchers have begun to examine EHR alert fatigue.
EHR alerts and care management
Evidence shows that using (and adhering to) CDS-based EHR alerts can improve patient health outcomes, cost efficiency, and potentially enhance care management. An observational study of 26,424 patient encounters spanning three years published in the American Journal of Managed Care indicates that adherence to real-time CDS alerts was correlated with consistent improvements on the following variables: length of stay, the probability of readmission after 30-days, the probability of complications, and total direct costs of care.
Improving patient health with EHR alerts
Besides alerts directed at clinicians to warn of potential risk, another example of using this technology to improve care management has been illustrated in providing reminders to patients to improve health care self-management. In this context, reminders and alerts can be used to notify patients about upcoming appointments, to encourage preventive screenings, as well as for vaccinations or medication adherence. In this respect, reminders may hold promise as the most effective way to enhance care management outside of the clinical setting which, in turn, may lead to better adherence to a patients prescribed health regimen, reduce no-shows, provide a supplement to discharge instructions, thereby reducing readmission rates, which in turn can and potentially reduce costs.
As institutions employ more sophisticated EHRs that have a greater to analyze clinical data and provide alerts, clinicians can be overwhelmed by alerts, as evidenced by a 2014 study which tracked the number of alerts presented by physiologic monitors in a 66-bed intensive care unit. The findings showed that these monitors gave off more than 2 million alerts in one month (187 warnings per patient per day). Another study examined the number of alerts generated by a CPOE system and found that the CPOE systems studied generated warnings for 3% – 6% of all the orders entered.
Research published in JAMA Internal Medicine illustrates the potential risk presented by alert fatigue. In a survey of 2590 PCPs, it was reported that the median number of alerts PCPs had been receiving each day was 63. Of the PCPs surveyed, 86.9% perceived the number of alerts they received to be excessive, and 69.6% reported receiving more alerts than they could effectively manage.
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Given that clinicians are often peppered with alerts throughout the day, alert fatigue becomes something that can temper our enthusiasm about the virtues of EHR alerts.
Alert fatigue describes the process of desensitization whereby recipients begin to ignore or fail to respond appropriately to these notifications. The outcome of alert fatigue is not merely an annoyance instead it can result in increased patient risk.
When used properly, the benefits that flow from the use of alerts and reminders are established. However, one should view these tools as not as a panacea; instead, they should be used in a way that supplements care rather than distract from it.
Jeff Green, MPH, JD writes for EHR in Practice. He is a consultant in the Healthcare Information Technology Space.