Survey: Too many EHR alerts could lead to missing test results

The information deluge unleashed by electronic health-record systems could cause physicians to miss notifications of abnormal test results, according to a survey of primary-care practitioners with the U.S. Veterans Affairs Department. Missing those notifications could delay needed care for patients, according to the physicians, nurse practitioners and physicians assistants surveyed.

Researchers from several Houston institutions—including the Houston VA Health Services Research and Development Center of Excellence—surveyed almost 2,600 VA primary-care practitioners from June 2010 through November 2010 regarding EHR-based alerts. Almost 30% acknowledged missing notification of test results that led to care delays, according to a research letter in the American Medical Association journal JAMA Internal Medicine (formerly the Archives of Internal Medicine).

Respondents reported receiving a median of 63 alerts a day, which 86.9% perceived to be excessive. Also, 69.6% said they received more alerts than they could manage. In addition to volume, other factors related to the perception and potential of missed test results included the usability of the EHR system and electronic handoff of a patient's record to another provider.

The researchers warned that just reducing the number of alerts without taking account of other factors in the “broader primary-care practitioner experience” would probably not be sufficient to improve outcomes.

“Nevertheless, our findings suggest that missed results in EHRs might be related to information overload from alert notifications, electronic handoffs in care and practitioner perceptions of poor EHR usability,” the researchers concluded. "Interventions to improve safety of test result follow-up in EHRs must address these factors.”

The study was funded in part by the VA National Center for Patient Safety and the National Institutes of Health.