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Medication Alerts Probed in Electronic Health Records

Alissa Russ (IUPUI)

Alissa Russ (Indiana University-Purdue University in Indianapolis)

Medical and engineering researchers in Indiana have investigated human and electronic factors behind the value of alerts in automated health records designed to warn prescribers of medication problems. The findings of the team from the Regenstrief Institute, Indiana and Purdue universities, and the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis appear in the April 2012 issue of the International Journal of Medical Informatics (paid subscription required).

Medication alerts provide health care providers with information on a variety of drug-related issues, including patient allergies, drug interactions, and duplicate prescriptions. These alerts can be triggered by such factors as the prescription of a new medication or a change in a patient’s lab tests.

For health care workers, however, these alerts can lose their effectiveness if they become too numerous, too verbose, or are considered irrelevant to the patient. The goal is to find the optimum design that provides vital information to health care providers without overwhelming them, a condition known as alert fatigue.

In this study, the researchers observed providers as they treated patients, to learn about the strengths and weaknesses of medication alerts. Physicians, pharmacists, and nurse practitioners were recruited from five primary care and eight specialty clinics.

The research team witnessed and analyzed 320 alerts generated by an electronic medical record (EMR) system for 30 prescribers and their interactions with 146 patients. From these interactions, the authors identified nine factors that influence prescribers as they encounter alerts, and described in detail 44 components that contribute to these factors.

The researchers found that prescribers are sometimes unsure why an alert was appearing. The findings also indicate that alert designs are more pharmacist-oriented than physician- or nurse practitioner-oriented, when in fact the main prescribers are doctors and nurse practitioners.

“Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems,” says Alissa Russ of the Roudebush VA Medical Center, first author of the study (pictured at top). “Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as EMR systems expand beyond single hospitals and share more data.”

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