Alert Fatigue and Overdependence: Two Sides of the Same EHR Coin

ACOEM Wants Occupational Data Included in EHRs

Impact of EHR Alerts

Amanda Guerrero
Twitter: @meanusenetwork

Electronic health record software promises enhancements in clinical and organizational outcomes. Yet, anyone who has implemented an EHR knows that improvements in care coordination, patient safety and financial performance are not always immediate. In fact, they can take extensive time and effort to achieve.

In some cases, EHRs can even have the opposite effects than the ones desired:

  • Creating extra expenses for healthcare organizations rather than cutting costs
  • Taking doctors twice as much time to document patient encounters instead of saving time
  • Causing unintended errors and leading to lapses in patient care

Healthcare professionals are increasingly complaining about these and other issues, affirming that it’s possible the disadvantages of electronic health record software could very well outweigh the pros – at least when it comes to haphazard implementations and poor training.

Alert fatigue

One of the most debated unintended consequences of EHRs is the overabundance of warnings and reminders generated by clinical decision support (CDS) tools, which can result in alert fatigue for physicians. While notifications are meant to help physicians by pointing out important information, EHR systems often produce excessive and unnecessary alerts. For physicians, that means one more box that needs to be clicked out of. When this happens and physicians start experiencing alert fatigue, notifications begin to get ignored or overridden causing important warnings to slip through the cracks. This can lead to negative treatment outcomes and even compromise patient safety.

Alert overdependence

On the other end of the unintended consequences spectrum is alert dependence. This occurs when healthcare providers rely too heavily on available technologies and stop thinking for themselves.

A physician dependent on clinical decision support tools, for example, might not be able to remember standard dosages and formulary recommendations in the event of a system outage. Even worse, physicians that depend on warnings about drug-drug and drug-allergy interactions could potentially prescribe a contraindicated medication if their alert system were to fail. Additionally, physicians accustomed to certain warnings or reminders might not realize that those same notifications are not available at another practice or location or with a different EHR.

To overcome these problems, vendors must design solutions that can aid physicians without wearing them out. If this is accomplished, however, and EHRs pop up just the right amount of notifications, will it contribute to EHR alert overdependence?

Amanda Guerrero is a content writer specializing in EHR, healthcare technology and Meaningful Use. In addition to maintaining her own health IT-related blog, she contributes to websites such as HealthTechnologyReview and