Physician electronic reminders ‘lead to information overload’
medwireNews: Electronic health records (EHRs) can lead to information overload and primary care providers missing important information, conclude US researchers from a survey of over 5000 clinicians.
Hardeep Singh (Michael DeBakey Veterans Affairs Medical Center, Houston, Texas) and colleagues report in JAMA Internal Medicine that well over four-fifths of respondents perceived the amount of alerts they received to be "excessive," while 70% said they received more alerts than they could manage.
The 105-item survey garnered responses on the potential for missed results, based on physicians' answers to the statements: "The alert notification system in Computerized Patient Record System as currently implemented makes it possible for practitioners to miss test results;" and: "In the past year, I missed abnormal lab or imaging test results that led to delayed patient care."
A total of 2590 (51.8%) primary care practitioners responded and the median number of alerts reported to be received each day was 63. Overall, 86.9% of respondents said this was excessive, and 69.6% said it was more than they could effectively manage.
Indeed, over half (55.6%) reported that the EHR notification system made it possible to miss test results, and almost a third (29.8%) said they themselves had missed results, leading to delays for their patients.
Analysis showed that perceived ease of EHR use was inversely related to the likelihood of missing test results.
Furthermore, the greater clinicians' concerns over electronic hand-offs, as revealed by the routing of alerts to the EHR of a surrogate practitioner, the more likely the potential for, and history of, missed results were.
Primary care physicians who reported receiving an unmanageable amount of alerts were twice as likely to report having missed results that led to patient care being delayed as those who reported no problems managing the volume of alerts.
However, the actual number of alerts that respondents reported receiving was unrelated to their reported possibility of, or history of, missing results.
The authors advise that simply reducing alert numbers without considering the broader primary care physician experience related to information overload "might be insufficient to improve outcomes."
"Because this was a cross-sectional survey, we cannot determine causation," they conclude. "Nevertheless, our findings suggest that missed results in EHRs might be related to information overload from alert notifications, electronic hand-offs in care, and practitioner perceptions."
By Caroline Price, Senior medwireNews Reporter