Electronic health record-based alerts can inadvertently lead to information overload for health care providers, according to a study published in the Archives of Internal Medicine, Medscape Medical News reports.
For the study, researchers from the Department of Veterans Affairs' Health Services Research & Development Center for Excellence in Houston extracted all "additional signature request" alerts -- defined as any note requiring an electronic signature -- that were transmitted to primary care physicians via an EHR system at a VA facility's outpatient clinics during a 160-day period.
The researchers then randomly selected 1%, or 536, of the alerts for further analysis. Two primary care providers rated the value of the alerts, based on the urgency with which a physician would need to follow up to avoid patient harm, the level of patient harm that could occur if the alert was missed and the subjective importance of the alert. Alerts that both reviewers identified as "urgent, potentially harmful if missed and important" were deemed high-value.
Of the alerts analyzed, 53.7% were identified as high value. Relaying medication refill requests and new or persistent patient symptoms were the two most frequent reasons for the EHR-based messages. The majority of alerts in these two categories were seen as high value, at 89% and 64.6%, respectively.
However, the researchers overall found that "inefficiencies in information transfer required PCPs to read through large amounts of extraneous text to find relevant information."
The average note had a median of 142 words, of which just 28 were considered relevant.
The researchers said that having other staff members follow up on the alerts or introducing a system to emphasize relevant text could help improve the situation.
In a related commentary, Michael McDonald of the University of Wisconsin School of Medicine and Clement McDonald of NIH said a survey they conducted found similar results.
They wrote that physicians and residents were "consistently negative about the [EHR's] effect on message management." They noted that survey respondents reported losing a median of 60 minutes and a mean of 48 minutes per day to computer use.
They warned, "If changes are not made to reduce or eliminate these time penalties on PCPs, there will be no PCPs left to penalize" (Johnson, Medscape Medical News, 2/14).