Example 15: Responding to Alert Fatigue

Issues Encountered

EHR systems often include decision support functionalities such as drug-drug interaction, drug-dose, drug-lab, and contraindication alerting. Several studies have identified "alert fatigue" (choosing to ignore alerts) as a common condition amongst clinicians using EHRs with decision support.

Finding a Solution

A review of the relevant research literature found that the majority of alerts are overridden. Multiple remediation options are available. The first option would be to deactivate the alerts entirely. A more measured approach might be to convene a panel of local physicians to determine which alerts should be turned on. Perhaps the most successful approach identified in the literature is implementing tiered alerts (e.g., minor, moderate, severe). Shah and colleagues found that this kind of approach significantly increased the acceptance rate of decision support alerts.

Lessons Learned

  • Interruptive decision support alerts can be a major source of user frustration and system inefficiency.
  • Careful consideration should be given to the type and frequency of alerts that are included in decision support systems.

Source: Shah NR, Seger AC, Seger DL, et al. Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care. J Am Med Inform Assoc 2006 Jan-Feb; 13(1): 5-11.

van der Sijs H, Aarts J, Vulto A, et al. Overriding of drug safety alerts in computerized physician order entry.

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