How to address EHR alert fatigue

Electronic health record (EHR) systems feature pop-up alerts designed to provide clinicians with useful patient information in real-time at the point of care. By delivering relevant information when needed, alerts assist with functions like medication oversight, lab results, and clinical decision-making. Customized, patient-specific notifications support positive patient experiences, improving health outcomes and patient retention.

But what happens when clinicians are constantly bombarded with pop-up alerts? Excessive notifications containing non-useful information can make the alert system seem irritating and intrusive, rather than supportive. A barrage of non-critical messages can stop providers from seeing crucial alerts at the right time. The EHR alert system designed to prevent errors and protect patients ends up undermining those same goals.

In this guide, we dive into how to identify EHR alert fatigue and strategies to mitigate it.

Alerts are intended to reduce preventable errors that can compromise patient safety. For example, a drug allergy alert can stop a provider from prescribing a harmful medication, while an abnormal lab results alert can help ensure timely follow-up on concerning conditions.

Exposing clinicians to a large volume of alerts often leads to “alert fatigue,” a condition that occurs when we see too many pop-up notifications, most of which aren’t relevant. Alert fatigue has been implicated as a significant factor in serious medical errors because it often prevents clinicians from seeing and taking action on critical alerts. Fatigue is also associated with clinician burnout.

Fortunately, informing yourself and your staff and addressing alert fatigue can lower the risk of adverse patient events, support better care delivery, and relieve clinician burnout to enhance professional quality of life.

​There are 3 primary causes of alert fatigue: 

When an EHR system generates a high volume of alerts it can overwhelm providers, causing them to see the system as a hindrance. A retrospective study published in BMC Medical Informatics and Decision Making in 2017 found that clinicians became less likely to accept alerts as the number of alerts increased.

The same study also found that in one year, an average of 25% of drug alerts and one-third of clinical reminders for a single patient included duplicate information. Receiving the same information over and over desensitizes clinicians to its relevance. 

Studies show more than two-thirds of all medication-allergy alerts are for non-life-threatening allergies. Data errors or inaccurate information can also trigger false alarms. Frequent false alarms encourage clinicians to distrust the alert system, making them more likely to override critical notifications.

A clinical decision support system (CDSS or CDS) is a tool that assists providers with medical decision-making. CDS automates clinical alerts intended to supplement the provider's own clinical knowledge and experience. However, CDS configurations may generate numerous irrelevant alerts, contributing to desensitization and alert fatigue. 

Identifying alert fatigue is crucial to improve alert management and reduce clinician overwhelm. Recognizing signs and symptoms of alert fatigue allows practices to implement optimization strategies before adverse consequences occur. 

Common indicators of fatigue in clinical staff:

Tracking specific metrics uses data to reveal patterns of alert overload, helping you identify target areas for improvements that reduce desensitization and overwhelm.

The following metrics provide insight into the impact of alerts on your clinical team: 

An EHR system tracks how clinicians interact with alerts, including which alerts are dismissed or accepted and which result in actions like medication changes, lab orders, or adjustments to the treatment plan. Alert-to-action shows trends such as which alerts are dismissed vs. those that correspond with meaningful actions. 

This metric centers clinician experience when evaluating how alert fatigue affects your practice. Research shows that the perceived level of alert fatigue can significantly impact the quality of clinicians’ professional lives.

To measure perceptions of fatigue, conduct surveys and feedback sessions that ask your staff to rank fatigue levels. Fatigue scores identify which areas urgently need interventions to streamline patient alerts.

The frequency of alert overrides reveals how many notifications clinicians deem irrelevant. Use EHR override data to evaluate the alert system's effectiveness and inform plans for customization or upgrades. 

Tracking how much time clinicians spend managing alerts can reveal which workflows are most impacted. Adjusting notifications based on this data helps streamline specific clinical workflows. This process also sheds light on the efficiency and customizability of the current EHR system.

If you’re concerned that alert fatigue is affecting your clinical team, it’s time to develop a strategy to assess and address EHR issues that contribute to desensitization. 

The key to preventing alert fatigue is to minimize the number of non-critical alerts clinicians and other healthcare professionals see daily and simplify information delivery. Establish a governance committee tasked with designing practice-specific policies, conducting routine assessments, and recommending modifications to improve alert effectiveness. 

Consider the following fatigue reduction initiatives:

Schedule routine evaluations regarding the impact of alerts on workflows and clinicians. Take advantage of EHR reports and data analytics highlighting specific patterns on critical metrics. 

Feedback from front-line users is crucial for the practical evaluation of the alert system. Set up monthly reviews with clinical teams to conduct surveys and gather user feedback. 

Training sessions ensure staff are educated on patient alert policies and protocols and understand how to operate the EHR features for setting and modifying notifications. 

EHR systems that allow practices to configure alert delivery help reduce the risk of alert fatigue for clinical and non-clinical staff.

Recommended actions:

Starting the intervention process now could save your practice from adverse events due to increased errors, reduced productivity, and the impact of burnout on care delivery and staff satisfaction.

Using a technology-driven approach focuses on making alert systems smarter and more customized. AI algorithms analyze clinical data in real-time, identifying patient risk levels with high accuracy so that alerts are sent only when necessary. These tools also evaluate alert relevancy to automatically suppress non-critical alerts. 

Effective strategies for mitigating alert fatigue focus on customization, clinician engagement, and interventions informed by data-driven insights using tailored solutions designed to meet the practice’s specific needs.

In 2015, Jurong Health Campus (JHC), a 700-bed public hospital in Singapore, implemented a new EHR system. The system significantly increased advisory alerts, leading to higher alert dismissal rates. 

Mitigating alert fatigue required improvements to make alerts more effective and increase clinician action on critical notifications while maintaining the risk reduction benefits of advisory messages.

Concerned about alert fatigue and clinician desensitization, JHC initiated a continuous, multi-pronged intervention strategy in 2019. 

The primary focuses of this strategy include:

Alert refinements were based on feedback, data analysis, and clinical best practices. 

After implementing these optimizations, JHC saw an average of 59% reduction in interruptive alerts across all clinical groups. It reduced total interruptive alerts by 74.3%. The system's overall effectiveness improved as clinicians took more action on alerts fired. 

A data-driven approach to managing EHR alerts relies on empirical analysis to identify import alerts from non-relevant notifications. Rather than relying on trial-and-error adjustments, this method examines complex data on crucial metrics, helping practices tailor alerts to specific tasks, clinical roles, or patient health history. 

A continuous approach to improving EHR patient alerts ensures your patient alert system maintains and enhances its effectiveness over time. Investing in continuous strategies and ongoing clinician engagement produces substantial, long-lasting benefits. This elevates the standard of patient care and the quality of professional life for dedicated team members.

Choosing an EHR platform with built-in tools and customizable alerts supports seamless integration of patient alerts with practice-specific workflows. To learn more about EHR alert features and how to select the best system for your practice, read our comprehensive EHR selection and implementation guide.