You can imagine the EHR Product Manager that had the great idea to alert physicians to a drug to drug interaction or an allergy issue. It seems obvious that an alert like this is going to help doctors provide better care to their patients. Who wouldn’t want a notification that something they were doing had a potential issue, right?
This sounds great until you get into the nitty gritty details. Turns out there’s a lot of nuance when it comes to drug to drug interactions. Many times a doctor may ignore the risk of the interaction given other clinical needs. These alerts that aren’t useful create alert fatigue really quickly.
It’s easy to see the quality manager wanting to place alerts in patients’ charts to notify the doctor of various value based care, SDoH, and quality concerns they have for a patient. Sounds great doesn’t it? Doctors get notified of important things they can address with the patient while they’re present with the patient.
Sounds great until you realize that the doctor has 15 minutes with the patient and barely has enough time to address the chief complaint. How are they supposed to fit all of this other care into such a short visit? It’s easy to ignore these alerts when pressed for time.
Regulations now require primary care doctors be notified if their patients have an ED visit or are admitted to a hospital. It’s amazing to think that PCPs are being notified about their patients so that they can ensure quality continuity of care. Far too often the primary care doctor never learns about these health issues that are addressed at hospitals.
It’s beautiful that PCPs can be informed in order to coordinate the care for their patients. However, if they’re not in a value based care arrangement, what are they supposed to do with that notification? I guess there’s some benefit to have that information the next time that patient comes for a visit. There’s also an opportunity to drive more patient visits so the PCP can follow up on what was done in the hospital or ED. Of course, if you’re a doctor with a 2 month waiting list, it’s easy to ignore these alerts.
We’ve all seen the explosion in patient messages through a patient portal. Patients love it and doctors are coming around on the idea that these messages can actually save them time since then they don’t have to play phone tag with the patients. In many EHR, these messages are part of an EHR messaging system where doctors get notifications from patients, nurses, billing staff, etc. It’s basically HIPAA secure email for doctors.
All of these messages provide convenient access to the doctor. At least it does until the doctor is overwhelmed with 100s of messages. Look at all the email pictures where people have 1000s and 10s of thousands of unread emails. Hopefully the spam in EHR messages won’t be quite as bad, but the way we’re dumping everything into EHR messages is heading in a similar direction. At some point the volume is so large that doctors start to ignore their messages.
I could keep going, but I think you get the point. Alerts are great until the person getting the alerts stop looking at them. When you look even at this small list of alerts and notifications that doctors are getting, it’s easy to see why alert fatigue is a major challenge in every healthcare organization. I expect one of the biggest efforts healthcare organizations will make over the next few years is refining and reducing the number of messages and alerts that are being sent to doctors.
Just because we can alert someone to something doesn’t mean we always should.
