Clinicians say they receive far too many alerts from electronic health record (EHR) systems. In addition to test-result alerts, they get many unnecessary notifications that complicate the task of reviewing the more urgent alerts. The flood of messages--up to 150 a day--adds to their already heavy clinical workloads, leaves them with very little time for the task of alert management, and frustrates the process of providing timely follow-up care.

That's the conclusion of a research report published in the April 12 issue of BMC Medical Informatics and Decision Making, which evaluated how Department of Veterans Affairs (VA) personnel are utilizing EHRs.

Despite what clinicians in the report said, however, the study also showed that EHRs can't always be blamed for the failure of doctors to act on patient information. In fact, on over 2,500 alerts of abnormal test results, providers did not read 18% of alerts pertaining to abnormal imaging results or 10% relating to abnormal laboratory tests. Furthermore, approximately 8% of abnormal imaging and 7% of abnormal laboratory results lacked timely follow-up at 30 days, the report said.

"Clinicians do not optimally utilize all of the functions in the EHR; for instance, we found that about half (46%) of clinicians did not use the specific features of the View Alert window that facilitate better processing of electronic alerts," the report said.

The report noted that there are many factors beyond the technology itself that will likely predict how "meaningfully" providers will use clinical decision support (CDS) tools for test-result reporting in the future.

Researchers conducted interviews between January and May 2009 with 44 healthcare employees working at two VA facilities. Among those participating were primary care providers and personnel representing diagnostic services (radiology, laboratory) and information technology.

In addition to their complains about too many alerts, respondents said EHRs fail to track and categorize relevant clinical information. To help fix the problems, they suggested better EHR capabilities to help visualize, organize, and track alerts.

This is not the first time that doubts have been raised about the effectiveness of EHR systems to improve the quality of care. A recent Stanford University study published in the Archives of Internal Medicine showed that electronic health records (EHRs) did not significantly improve the quality of patient care, even when they were used with CDS systems that help healthcare professionals make clinical decisions to better manage care for patients.

The Stanford study was resoundingly criticized by Dr. David Blumenthal, former national coordinator for health IT, who said the study was conducted from 2005 to 2007, and relied on data that did not reflect modern EHR systems that adhere to meaningful use requirements.

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