EMR alert fatigue: Can we learn from the aviation industry?

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Anyone with a computer or smartphone is well aware of the incessant alerts that flash across the screen, often accompanied by a beep or exclamation point. The alert may be for an upcoming appointment, a reminder of an acquaintance’s birthday — or a just-announced sale at your favorite online retailer.

How many of these alerts are really important? It’s easy to ignore a media news flash — but what if you miss an important alert about the cancellation of your flight?

“Alert fatigue” describes our reaction to the unmanageable and sometimes overwhelming barrage of electronic alerts. The Agency for Healthcare Research and Quality describes “how busy workers become desensitized to safety alerts and as a result ignore or fail to respond appropriately to such warnings.”

All told, missing the birthday of a Facebook friend or not hearing that your favorite football team has a new quarterback is hardly life-threatening. In the medical world — such alerts may mean the difference between life and death.

Alerts may be from monitoring systems or from the electronic medical record. Physiologic monitors, for example, in hospitals and especially in intensive care units exist to alert staff when vital signs go outside a predetermined range. This is important stuff, obviously — particularly the alert that says the heart has stopped beating.

Electronic medical records may also alert physicians to key safety issues, such as prescribing a medication to which the patient is allergic. But these alerts may also serve as a reminder the patient needs a vaccination or that his or her cholesterol pill is due for a refill — hardly life-and-death matters.

So why not just ignore these alerts? A 2011 Boston Globe investigation found that more than 200 deaths over a five-year period were attributable to not heeding alarms from bodily monitoring systems. So shutting off the alerts has its own bad consequences.

Then again, more than half of these safety alerts are ignored by harried clinicians. What if they ignore not the pap smear reminder, but the potential fatal interaction of the drug they are about to prescribe?

The purpose of these alerts is to prevent medical errors, which Johns Hopkins researchers say are the third leading cause of death.

What’s the fine line between excessive alerts, the incessant computer nagging, and the safety benefits (hopefully) realized through such alerts? How can alerts be filtered to weed out the irrelevant — and to bother doctors only when absolutely necessary?

This is not an easy task. At a systems level, there are legal ramifications to removing alerts. What if something is missed due to no alert? But at a practical level, important warnings may simply be ignored due to alert fatigue.

Perhaps lessons can be learned from the aviation industry. Busy pilots might be alerted to myriad anomalies in the highly complex machines they fly. Yet they only hear of the consequential alerts, a landing gear not deploying rather than a blown fuse in the galley, allowing them to focus on the task at hand — flying the plane and remaining fully aware of their flight experience.

As medical record systems evolve, the hope is that alert algorithms will better separate the wheat from the chaff, grabbing a few moments of a busy physician’s attention only for vital matters, not a flu shot reminder or a suggestion to try a generic drug instead.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in the HealthZette.

Image credit: Shutterstock.com

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