EHRs are supposed to streamline the copious amounts of information that hospitals and clinics handle on a daily basis. And for the most part, EHRs do their job well. However, a new study in the February 13, 2012 issue of Archives of Internal Medicine says that EHRs might lead to information overload, further burdoning health care staff with alerts and information.
The study took place in the large outpatient clinics of the Department of Veterans Affairs facility. In these clinics, the EHR system has a mechanism to alert staff when an additional signature is requested; these are called ASR Alerts. This alert goes off when there’s any note that requires an additional signature.
The researchers pulled all these alerts (there were over 53,000) that were transmitted to any primary care physician during a 160-day period. They randomly selected 1% of these alerts (an exact total of 536) for further study.
Two reviewers rated the “value” of the alerts; the value was determined based on the urgency of the alert, and the follow-up needed to avoid potential patient harm, and the level of harm the might occur of the primary care physician missed the alert. The also assessed the value of the alert on the subjective importance of it in regards to the primary physician’s care.
So, “high value” alerts were any alerts that were “potentially harmful if missed, urgent, and important.”
The good news is that 282 of these alerts, over 50%, were considered high value. However, the researchers were quoted in Medscape, saying “but inefficiencies in information transfer required PCPs to read through large amounts of extraneous text to find relevant information.”
The most frequent reasons for alerts being sent to physicians was to notify them of patient medication refill requests, or to communicate new or persistent symptoms. Most of the alerts required considerable processing time.
Overall, the researchers concluded that few alerts (less than 15%) were non-essential. However, because there was a lot of extraneous wording to wade through within the alerts, physicians felt that EHRs were contributing to information overload. They also felt that considerable time was being lost reading through all these alerts.
The researchers then looked at 7 physicians from two family care practices, to see how much time, on average, was “lost” on the computer. According to their observations, these physicians lost an average of 48-60 minutes of “free time” to the EHR.
So, the lesson is this. EHRs are incredibly useful for hospitals and clinics, and they do serve an important role in preventing patient harm. However, physicians are still complaining about the time lost in the EHR inbox: message management needs to improve. Hopefully, as EHRs continue to evolve, message management will get more efficient, resulting in less time wasted wading through non-essential information.