Alert Fatigue: RxPert Discusses Challenges for EHR Development and Interoperability

Monday, March 27, 2017

The problem of alert fatigue — the negative or overwhelmed reaction of clinicians to receiving too many intrusive or irrelevant notifications from electronic health record (EHR) systems — continues to vex clinicians, software developers, and informatics specialists. Clinical Innovation & Technology industry news website recently took a deeper look at the problem with “Q&A: Informatics expert sets off alarms on alert fatigue”, an interview with Wolters Kluwer Clinical Drug Information’s director of informatics and clinical innovation, Shobha Phansalkar, RPh, PhD.

In the article, Phansalkar notes that users override 49-96% of medication decision support alerts, including many that are clinically significant. By ignoring meaningful alerts, clinicians increase their risk of prescribing, dispensing, or administering a medication that may be contraindicated, an inappropriate therapeutic choice, or an incorrect dose.

“In order for CDS (clinical decision support) to continue to evolve, developers must not only direct more and better content into the hands of providers, they must also get a deeper understanding of how to deliver content that is not so voluminous or irrelevant that it overwhelms the user, disrupts the workflow and creates a risk of alert fatigue where valuable information is lost in the background noise of unhelpful information,” Phansalkar says.

Context Is Key

The best approach to addressing alert fatigue, Phansalkar says, is developing CDS systems with deeper context, whether about the clinical care setting or the patient. If EHR system logic is able to access and understand more specific information, the alerts it generates will be more meaningful, more precise to the situation, and more useful. There will also be fewer alerts generated overall, as the greater context will help eliminate extraneous, more general warnings.

Simply put: “Clinicians receiving more useful alerts are less likely to suffer from alert fatigue.”


The industry-wide push toward interoperability would allow CDS systems to draw and share more information from disparate systems. However, Phansalkar notes, it is still unknown whether these advances in information exchange and standardization will increase or decrease alert fatigue. “On the one hand, more data may lead to more alerts,” she explains. “On the other hand, a broader data pool, if used effectively, has the real potential to improve the specificity of alerts and reduce alert fatigue.”

Read the whole article from Clinical Innovation & Technology.

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