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In theory, the more you alert a provider to potential problems, the better care the patient will receive. Of the many helpful features included within the framework of an electronic health record (EHR), provider pop-up alerts can simultaneously be one of the most positive and most negative – depending on how they’re implemented.  Too many alerts can lead to alert fatigue, which can be an alarming problem.

If implemented without proper alignment, alerts can have the inverse effect.  When providers are inundated with pop-up messages, they focus less on the patient and their goal becomes getting out of the system instead of using the specified information to help the patient.

When an EHR is implemented for the first time, or an update is being installed that includes an increase in alerts, the IT or project team can feel that additional alerts inherently means increased patient safety.  However, that’s not necessarily the case.  If alerts aren’t set up properly, they can downgrade patient care.  Alert presentation and timing must be thoroughly vetted to ensure success.

A good rule of thumb to follow for EHR alerts: less is more.  When implementing new alerts, start slowly.  Test, test, test on the backend.  Make sure they’re firing at the appropriate time and with pertinent information.  If an alert is set to pop-up when steroids come into play, that must be tested thoroughly to ensure that medicines that include steroids, such as eye drops, aren’t flagged when it’s not necessary.  There’s a direct correlation between unnecessary alerts and alert fatigue.

Unfortunately, alerts cannot be completely vetted in the test environment.  The best way to test for negative impacts, once testing in the test environment is complete, is to launch the alerts in the background of the live environment.  Make the alerts available for analysts to test, but not visible for end users.  No matter how thorough your application team is, they can never simulate every possible scenario that clinicians face when seeing patients in the live environment.

Additionally, it’s not a great practice to install pop-up alerts at the request of someone who is not receiving the alert.  For example, if HIM wants providers to get a pop-up to elicit a specific action or if nurses want physicians to get an alert.  Typically, these aren’t effective as they don’t help the provider, in the example, do their job.  Alerts should help the recipient do their job or improve patient care, not try to get someone to perform an action desired by another department.

A couple of things to keep in mind when setting up pop-up alerts:

  • Alerts should provide ways to address issues or provide more information about issue, and
  • Alerts should be integrated into the clinician’s decision-making process.

With a recent client, Optimum’s team of EHR experts analyzed medication alert results over the span of a few months and the results were alarming.  Due to the system’s settings, the average clinician using the medication software received 49 alerts for every 100 medications they ordered – meaning that every other medication they ordered initiated a pop-up alert!

The team reviewed why the alerts were firing and how they could be tweaked. By conservatively reviewing and editing alert patterns and when alerts were displayed over four months, they reduced the rate of alerts from 49/100 to 27/100.  The data also showed that when alerts were elevated, only 12% resulted in changes. At 27 alerts per 100 medication orders, 33% of the alerts resulted in changes. Increased alerts don’t necessarily lead to increased patient safety.  Sometimes less really is more.

The major takeaway is that just because you can implement every alert available in the system, doesn’t mean you should. Alerts must be strategically presented at the right place and time in the workflow to avoid alert fatigue.  Sometimes it’s better to make the information visible and available so clinicians can act upon it in their own time, instead of in pop-up windows that force them to take their mind off the patient.

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