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Doctors overlook drug red flags in electronic medical records


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http://www.fiercehealthit.com/story/too-many-medical-alerts-too-little-time-new-study-restates-obvious/2012-03-29 Will EMRs make medical treatment safer? Think again.

 

Overabundance of medication alerts too detailed to help busy docs

By kterry Mar 29 2012 www.fiercehealthit.com

 

Too many medication alerts exist in electronic health records, and often times those alerts contain warnings that are too detailed to help busy clinicians, according to a new study [1] by Indianapolis' Regenstrief Institute and the U.S. Department of Veterans Affairs (VA). The institute calls the study first "in-depth look" at how physicians react to such alerts in EHRs.

 

Researchers followed 30 doctors, nurse practitioners and pharmacists as they treated 146 patients in outpatient clinics and received 320 medication alerts, including warnings about patient allergies, drug interactions and duplicate prescriptions. They observed and analyzed factors that contributed to how clinicians responded to the alerts.

 

Their paper, published in the International Journal of Medical Informatics, notes that prescribers were sometimes unsure of why an alert was appearing. The prompts seemed to be more oriented to pharmacists than doctors or nurses, despite the fact that the latter were the alerts' main recipients.

 

....

In many organizations, alert fatigue may be even more pronounced than it was in the presence of the Regenstrief researchers. According to one study [2] published in the Journal of the American Medical Informatics Association, "physicians in various care settings override or ignore 49 to 96 percent of all alerts." Another study [3], published in Health Affairs, points out that EHR vendors purposely maximize the number of alerts in their products--and make it difficult for providers to adjust those alerts--in order to reduce their exposure to liability suits.

 

The authors of the latter paper, who believe these liability concerns are overblown, suggest that alerts be tailored to particular care settings or specialties, or the characteristics of individual patients. Physicians would be less likely to ignore the tailored alerts, they contend, because the warnings would seem more relevant to them.

 

....

Related Articles:

'Alarm fatigue' reduction efforts underway by FDA, Joint Commission [5]

Expanding side-effect labels 'overwhelm' docs [6]

 

Source URL: http://www.fiercehealthit.com/story/too-many-medical-alerts-too-little-time-new-study-restates-obvious/2012-03-29

 

Links:

[1] http://www.sciencedirect.com/science/article/pii/S1386505612000135

[2] http://jamia.bmj.com/content/13/2/138.abstract?sid=01df92c0-0865-4075-9198-bb123a02b1b2

[3] http://content.healthaffairs.org/content/30/12/2310.abstract

[4] http://www.fiercehealthit.com/press-releases/making-medication-alerts-electronic-medical-record-systems-more-useful-and-

[5] http://www.fiercehealthit.com/story/alarm-fatigue-reduction-efforts-underway-fda-joint-commission/2012-03-26

[6] http://www.fiercehealthcare.com/story/expanding-side-effect-labels-overwhelm-docs/2011-05-24

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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To me this is just bad software development practice. In my line of work we use Human Factors Engineers to study whether the computer-human interface is working. You'd be surprised how quickly you get to alert-fatigue. But using HFE's to study the contributing factors surrounding the human-computer interface it is possible to create changes in design that can result in more efficient communication between the computer and the human. It is important to take it all a step further and make sure the design works in the real world.

 

It is one thing to study the interface in a sterile environment, but quite another to study the interaction in the fast-paced, pressure-filled environment that many people actually work in.

 

The other possibility is that there are so many legitimate alerts that it speaks to how out of control the health care environment is - and that is even scarier, but unfortunately, likely.

 

Karma

2007 @ 375 mg Effexor - 11/29/2011 - 43.75 mg Effexor (regular) & .625 mg Xanax

200 mg Gabapentin 2/27/21 - 194.5 mg, 5/28/21 - 183 mg, 8/2/21 - 170 mg, 11/28/21 - 150 mg, 4/19/22 - 122 mg; 8//7/22 - 100 mg
Xanax taper: 3/11/12 - 0.9375 mg, 3/25/12 - 0.875 mg, 4/6/12 - 0.8125 mg, 4/18/12 - 0.75 mg; 1/16 0.6875 mg; at some point 0.625 mg
Effexor taper: 1/29/12 - 40.625 mg, 4/29/12 - 39.875 mg, 5/11/12 - Switched to liquid Effexor, 5/25/12 - 38 mg, 7/6/12 - 35 mg, 8/17/12 - 32 mg, 9/14/12 - 30 mg, 10/19/12 - 28 mg, 11/9/12 - 26 mg, 11/30/12 - 24 mg, 01/14/13 - 22 mg. 02/25/13 - 20.8 mg, 03/18/13 - 19.2 mg, 4/15/13 - 17.6 mg, 8/10/13 - 16.4 mg, 9/7/13 - 15.2 mg, 10/19/13 - 14 mg, 1/15/14 - 13.2 mg, 3/1/2014 - 12.6 mg, 5/4/14 - 12 mg, 8/1/14 - 11.4 mg, 8/29/14 - 10.8 mg; 10/14/14 - 10.2 mg; 12/15/14 - 10 mg, 1/11/15 - 9.5 mg, 2/8/15 - 9 mg, 3/21/15 - 8.5 mg, 5/1/15 - 8 mg, 6/9/15 - 7.5 mg, 7/8/15 - 7 mg, 8/22/15 - 6.5 mg, 10/4/15 - 6 mg; 1/1/16 - 5.6 mg; 2/6/16 - 5.2 mg; 4/9 - 4.8 mg; 7/7 4.5 mg; 10/7 4.25 mg; 11/4 4.0 mg; 11/25 3.8 mg; 4/24 3.6 mg; 5/27 3.4 mg; 7/8 3.2 mg ... 10/18 2.8 mg; 1/18 2.6 mg; 4/7 2.4 mg; 5/26 2.15mg; 8/18 1.85 mg; 10/7 1.7 mg; 12/1 1.45 mg; 3/2 1.2 mg; 5/4 0.90 mg; 6/1 0.80 mg; 6/22 0.65 mg; 08/03 0.50 mg, 08/10 0.45 mg, 10/05 0.325 mg, 11/23 0.2 mg, 12/14 0.15 mg, 12/21 0.125 mg, 02/28 0.03125 mg, 2/15 0.015625 mg, 2/29/20 0.00 mg - OFF Effexor


I am not a medical professional - this is not medical advice. My suggestions are based on personal experience, reading, observation and anecdotal information posted by other sufferers

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The prompts seemed to be more oriented to pharmacists than doctors or nurses, despite the fact that the latter were the alerts' main recipients.

I agree, Karma. It sounds like these systems need major Human Factors work! Probably they've been taken on by software companies that rely on engineers to make the usability decisions.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Another study [3], published in Health Affairs, points out that EHR vendors purposely maximize the number of alerts in their products--and make it difficult for providers to adjust those alerts--in order to reduce their exposure to liability suits.

 

 

Ah, but here's the catcher in the rye. It's all about legal liability, not about ease of use.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


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Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

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Right, but a good Human Factors designer would figure out a way to do both.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator Emeritus

Right, but a good Human Factors designer would figure out a way to do both.

 

I think you're right, Alto, but I'm a cynic. A good Human Factors designer is no doubt costly, and so many of these medically-related "services" are geared toward profit, not helping doctors or their patients. Never mind if people get disabled or worse from ill-prescribed medications and combinations thereof - it's all about the bottom line.

 

Many of our large money-making businesses are completely amoral. I remember reading something recently about many CEO types being diagnosable as sociopaths and that didn't surprise me at all. My doctor is a cheapskate. My dentist goes crazy when a patient cancels an appointment and doesn't make another one right away. My podiatrist schedules appointments every nine weeks whether you need it or not. Quest Labs now demands a fifty dollar deposit before they'll draw blood, just in case the insurance company doesn't pay. And it isn't just the medical profession that has its eye on the money.

 

I'm a CPA and spent the last seven years of my working life auditing insurance companies, everything from Blue Cross to tiny fraternal organizations and little niche companies specializing in services like title insurance. There was only one that truly had any concern for its policy holders, a small fraternal that not only offered burial insurance, but actually helped its members to learn English as a second language and get jobs.

 

Once when I was expressing confusion over a situation, a friend told me to "follow the money". That was years ago and the advice is still right on.

Psychotropic drug history: Pristiq 50 mg. (mid-September 2010 through February 2011), Remeron (mid-September 2010 through January 2011), Lexapro 10 mg. (mid-February 2011 through mid-December 2011), Lorazepam (Ativan) 1 mg. as needed mid-September 2010 through early March 2012

"Never attribute to malice that which is adequately explained by stupidity." -Hanlon's Razor


Introduction: http://survivingantidepressants.org/index.php?/topic/1588-introducing-jemima/

 

Success Story: http://survivingantidepressants.org/index.php?/topic/6263-success-jemima-survives-lexapro-and-dr-dickhead-too/

Please note that I am not a medical professional and my advice is based on personal experience, reading, and anecdotal information posted by other sufferers.

 

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Ahem, having been in the HF design field, I can tell you a good HF designer costs less than an engineer. It costs a LOT more to fix these applications when these problems show up than it could ever cost to do user-centered design from the start.

 

The usability issues showing up in EMRs are because the management of the process is technology-centric rather than user-centric. This happens all the time. It's not really because of the cost, it's a cultural issue.

 

As technology-centric software engineering takes over more and more of our lives, this will become more and more evident.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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