Journalist James Surowiecki said, in an article that ran in the New Yorker,
“Technology is supposed to make our lives easier, allowing us to do things more quickly and efficiently. But too often, it seems to make things harder, leaving us with fifty-button remote controls, digital cameras with hundreds of mysterious features and book-length manuals, and cars with dashboard systems worthy of the space shuttle,”
He expressed what so many of us experience as we try to stay on top of all the latest gadgets in our always-on, always-connected world. Unfortunately, doctors are not immune to this malady in their professional lives either. In fact, many doctors are frustrated by the fact that electronic medical records (EMRs), which were intended to make their lives much easier by helping to speed up and improve a variety of processes, are simply making them dog-tired.
What’s the problem?
What specifically is the problem with the much-heralded technology? Doctors are finding that EMRs can result in bouts of information overload as well as some debilitating fatigue as a result of the myriad sets of data, notifications, and alerts generated by some of the systems they use today. While much of this information is specifically vital to the care of their patients, but some is not. As a result, some physicians either ignore or turn off the notifications completely.
While physicians need various types of information to make the best care decisions for patients, exhaustion tends to set in as a result of the hundreds of alerts, notifications, and data sets they receive each day. To prevent clinicians from bypassing the majority of these alerts, group practices should leverage various technologies and best practices to achieve what every physician wants: a balance of giving physicians the most essential information without the distractions of data they could live without.
Industry experts are beginning to take note of this clinical information overload—and its unintended consequences. The good news is—that if handled correctly—physicians can have their electronic cake and eat it too. That is, they can enjoy all of the benefits of EMRs without the drawbacks associated with information overload and alert fatigue.
What do the surveys say?
While EMRs provide loads of great information to physicians, sometimes the deluge of data is just too much. For example, according to a recently published study in JAMA, primary care physicians spend more than an hour a day of unreimbursed work time reviewing the information notifications that keep popping up on their computer screens. The research notes that primary care physicians receive about 77 alerts via their EMR systems—twice as many as specialists.
These doctors are not the only ones struggling with technology, though. Another study claims that intensive care unit (ICU) physicians also are experiencing information overload, having to monitor about 2.5 million data sets over a 31-day period or 187 alerts per patient per day.
While some of this information comprises notifications from an EMR application, it also includes more detailed lab data, drug orders, microbiology reports, x-rays, and various vital signs produced by other information systems.
Although most of these types of clinical data sets arguably could be essential to patient care, the flood of information can severely affect a physician’s ability to analyze it, possibly resulting in inadequate decision making, poor communication, and overlooking potential life-threatening situations. Definitely not the technology’s intent.
What’s more, because medical group practices are using various data systems that don’t integrate, physicians could receive conflicting information, alerts, and notifications amongst the systems, which might result in them having to compare and analyze additional information. This disparate data ultimately could lead to delayed care, discrepancies in payer reimbursements, and possibly compromised patient safety or medical errors.
Limiting the annoyance factor
There are ways, however, that group practices can alleviate physician data fatigue and prevent this data overload and other atrocities that can stem from it.
First, organizational leaders need to periodically review the specific types of information that are useful to their providers’ daily workflow. They also should break them down further, ensuring that they have a minimum data set they want to require for each specialty, including nurses, compliance officers, and other care quality staff. Provider organizations also should assess and include the information they often are missing for billing, regulatory, operational, or care-quality purposes.
But that’s not all. They also need to involve physicians in the process of deciding what types of information, alerts, and notifications they believe are essential to help them better care for patients. This not only will ensure they get the alerts they need, but also that they use the information as intended.
Defining alert fatigue
Organizations should ask physicians specifically what alert overkill means to them. Writing in his blog, DirkMD-CMIO Perspective, Dirk Stanley, MD, pointed out that information overload could kick in at any of the following points for various physicians:
- When the system gives them too much information and they miss the important information
- When they just can’t read the alerts
- When they click bypass or acknowledge without actually reading the alert
- When the system tells them about one drug interaction, but they miss another
Healthcare organizations should use these and other clinician input statements to better determine how many notifications their staff can handle. Once they have decided what kind and how much information its physicians can handle, they can better agree on what specific alerts should be turned off, tone down the frequency of other essential ones, or create more role-based alerts within their information systems.
Attacking the problem
In a blog post published by HIMSS last year, Brian Pickering, MD, attending anesthesiologist & critical care physician, Mayo Clinic, recommended a multi-pronged approach that includes elements such as:
- Specific alerts validated through real world clinical trials
- Application of human-centered design principles to the design and integration of alerts into clinical environments to minimize disruption of workflow
- Alert prioritization that would enable only high-level alerts to interrupt workflow
- Refocusing on “failure to rescue,” issue alerts only when providers fail to act in an appropriate fashion to an emerging patient safety threat
- Engagement of stakeholders (providers and patients) in the design and implementation of new alerts
Biting the hair of the dog that bit you?
While it may seem that technology is the source of much of this information overload, it also can be used to alleviate some of it. For example, some systems, such as mine, Revenue XL’s EHR, can be customized and reconfigured to optimize the data and alerts they send to physicians. This can be achieved in multiple ways.
EMRs also can be modified using add-on technologies, such as clinical decision support systems. These types of applications often make it easy for organizations to prioritize alerts into tiers as well as separate alerts that make more sense to be sent to pharmacists rather than clinicians, such as drug interaction information.
Using artificial intelligence
Some new technologies also can make it easy for organizations to further customize their information systems so clinicians don’t have to spend as much time retrieving data in response to an alert. Such systems, instead, can simultaneously offer specific notifications with related real-time patient data to back them up.
These types of applications, based on artificial intelligence, are easier to use when patient data is collected and accessible via an integrated, unified longitudinal database. They can be used to analyze and identify patterns in a patient’s clinical information, compare it with patterns of other similar patients, take into consideration of all the health-plan specific preferences set for that patient, and create a unified care plan.
While enabling such artificial intelligence across a delivery system could require some internal policy changes as well as similar adjustments to payer agreements, such a plan would enable automatic authorization and order creation, thereby alleviating providers of much of multitude of alerts and notifications that would have been generated along the care process to achieve the same goal.
To further round out this type of integrated data platform in an effort to reduce physician information overload, healthcare organizations can use various types of patient-facing applications that enable self-reported data to be integrated into their information systems. Such technologies include web and mobile applications, wearable devices, and other technologies that enable patients to not only be more responsible for reporting various data, but also be more involved in their overall care.
While it could take a major shift for patients to become engaged with these types of technologies and applications, the integration of such data as well as their analysis by artificial intelligence systems could not only dramatically reduce the alert fatigue many physicians currently experience, but ultimately lead to more self-care management by patients and improved care overall.