Electronic Health Record Systems & Maryland Medical Malpractice: The Dangers Of “Alert Fatigue”

The majority of medical practices have adopted systems of electronic medical records (EHR), which have become virtually essential in today’s healthcare environment. The Maryland Health Care Commission (MHCC) is largely involved in the promotion of technology throughout the state. The MHCC also provides information regarding incentives for EHR implementation and usage. As is common with most newly implemented technology, there are certain problems including different user preferences and settings that may need to be customized. One potential problem among EHR users is “alert fatigue,” which begins when alert “pop-ups” occur continuously while working in the system. Users may become irritated when the alerts are unimportant, not applicable to them, or happen too frequently; this may lead users to disable the alert function altogether.

A common reason for alerts is drug interactions that the system recognizes; when these occur, users may be forced to stop and close the alert. Estimates suggest roughly two-thirds of all alerts are either overridden or are never seen because the alert function has been disabled. Disabling the alerts completely can create problems when the alert could have prevented a critical error or mistake. Alert fatigue is one of the primary complaints among EHR users in addition to problems with integration, the inability to interface with other EHR systems, and confusing or cumbersome operation.

Gregory Paulson, executive director of the Trenton Health Team, explains that clinicians often find these alerts disruptive when working in the EHR when suddenly “it gives you information the technology thinks is important and wants you to do something to fix it.” He used the analogy to describe these unwanted interruptions as similar to pop-up advertisements that occur when visiting a certain website, increasing the likelihood that the user has a negative view of the experience.

Many alerts are important, such as ones showing that an incorrect dosage of a medication was prescribed; however, far too many of these may indicate things the user was already aware of. Alerts may be classified according to their seriousness, such as by categories considered minor, moderate, or critical. One program called AlertSpace allows providers many options for customizing by enabling, disabling, or adjusting the frequency of occurrence. The program allows these prompts to be adjusted to the needs of the specific user and tracks the alerts so that reports can be reviewed for quality control purposes.

Alert fatigue could ultimately have a role in creating a problem leading to a medical malpractice claim, or it could have a significant impact on the outcome of a lawsuit. Medication-related mistakes are often the reason for malpractice suits, and e-prescribing systems that are either standalone or within an EHR have notoriously lead to many. Often the evidence in these cases largely consists of the documentation retained in an EHR. These medical record systems are not “one-size-fits-all” solutions in the majority of applications. It is important that providers take the time to properly customize settings, encourage clinician feedback, and proactively address EHR deficiencies long before discovering them during a malpractice case.