It takes just a jiffy to send an online message – compare that to the days gone by, when paper-based systems made sending messages an onerous task. That is an improvement in our fast paced world today, or is it? The ease and speed of instant messages has resulted in people sending and receiving far too many messages which take more time and concentration to read, absorb and act upon. Does the beep of an incoming message break your concentration from the job at hand? Do you feel compelled to check the message immediately in case it could be something important? Are you overwhelmed by the large number of messages that you receive? Do you find these messages interrupting your concentration while you are performing a critical job? Now, imagine you are a physician treating a patient – and these messages keep breaking your concentration and taking you away from the job at hand. Working in a hospital is distracting as it is, with the constant flow of patients, doctors, phone calls, emails and paperwork; add to that another level of communications in the form of EHR inboxes and you have added another source of interruption.
According to a study published in JAMA Internal Medicine, primary care physicians and specialists are getting overwhelmed by the large number of notifications from commercial EHR systems, resulting in alarm fatigue. Alarm or alert fatigue occurs when the large numbers of notifications received by EHR software becomes overwhelming for the healthcare provider. The study found that physicians spend on an average 66.8 minutes per day processing notifications from EHR use – not a huge amount of time per se, but, these 66.8 minutes are spread across the day, resulting in constant interruptions and break of concentration for the physicians. Meaningful use requirements and EHR Incentive Programs have resulted in hospitals installing EHR platforms and healthcare providers using more commercial EHR inboxes.
Notifications coming over the EHR include referral responses, test results, prescription refill requests and messages from other healthcare providers. Any of these notifications could require an urgent or immediate action; and thus the healthcare provider is compelled to look at it the moment it arrives. The study investigates the methods used by physicians to sort through these large numbers of EHR based notifications to sift out information that is important for quality care. The researchers cited a previous study conducted by the Department of Veteran Affairs that found alarm fatigue leading to a larger number of occurrences of overlooked test results and missed information.
Analyzing EHR inboxes of 92 physicians at 3 large practices in Texas, the researchers went through 276,207 notifications received during 125 work days. According to the research, primary care physicians received a mean of 76.9 notifications per day, out of which 15.5 notifications were related to test results. Compared to this, specialists received only 29.1 notifications with 10.4 related to test results. The majority of notifications in both cases were from pharmacies or other physicians. According to the researchers, “Because a single notification often contains multiple data points (e.g., results of metabolic panels contain 7-14 laboratory values), the actual burden and required cognitive effort required of the physicians is likely greater. Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed.”
Vineet Chopra, in a 2014 JAMA article titled ‘Redesigning Hospital Alarms for Patient Safety’ had written, “The consequence of this well-intentioned generalization is epitomized in the din of chirps, beeps, bells, and gongs that typify hospitals today. It is thus not surprising that concerns regarding safety have emerged, even in populations for whom these protective devices were once considered most valuable.”
However, EHR systems offer healthcare providers with a fast and efficient method of conveying information and data – an aspect that can make a huge difference in critical situations. A proper automated EHR system can decrease the amount of stress faced by healthcare providers, provided they work out a way to balance their EHR use. The study concludes that improvements need to be developed to make EHR systems more beneficial for both patients and physicians.
