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EHR Alarm Fatigue May Lead Physicians to Quit Their Jobs

By Jennifer Bresnick

Poorly designed EHR alarms may be pushing physician dissatisfaction to the breaking point.

- Too many EHR alarms and alerts may cause frustrated physicians to quit their jobs and seek employment elsewhere, especially if their interactions with the EHR system were monitored.  Physicians have long complained that the overabundance of pop-ups, notifications, check-boxes, and emails is highly distracting to patient care and produces sensory overload that may increase negative perceptions of health IT while severely reducing job satisfaction.  A new study in the American Journal of Managed Care adds evidence to the notion that poorly designed EHRs may be contributing to early retirements and higher turnover among fed-up physicians.

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A research team asked 2590 providers, including physicians and non-physician clinicians, within the Department of Veterans Affairs system about their perceptions of EHR alerts, their job satisfaction, and the likelihood of quitting their positions.  The researchers found that providers who perceived EHRs and health IT as a positive development in healthcare were more likely to be satisfied with their work and less likely to quit.  Providers at facilities with higher turnover rates have lower perceptions of the value of EHR alerts, and are more likely to view EHR notifications as yet another demand on their time instead of a benefit for care coordination.  Providers reacted particularly negatively to being monitored and given feedback on their interactions with the system, the study found.

“[EHR alerts] likely represent one of the most frustrating components of EHRs for providers,” the study says.  “Compared with paper communication systems, they are perceived to ‘increase the number of work items, inflate the time to process each, and divert work previously done by office staff to them.’  Other work has shown that providers perceive many of the alerts they receive to be unnecessary, and has documented variable physician acceptance of features like computerized reminders and electronic alerts.”

In 2013, a research letter in JAMA Internal Medicine noted that 87% of physicians believe the number and frequency of EHR alerts is “excessive” while using the same VA technology as the more recent study.  Physicians were likely to gloss over important information due to poorly designed alerts that don’t distinguish between routine and critical data, and may put their patients at risk for adverse events when important information is missed.  An incorrect paper-based workflow that bypassed electronic drug interaction alerts was blamed for three deaths at the Memphis VA Medical Center last year.

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  • “EHR alert systems, and by extension EHRs, could become catalysts for turnover, unless providers clearly understand their value to delivering high-quality care effectively and efficiently,” the study concludes. “As evidenced by the non-significant relationships between monitoring/feedback and provider satisfaction, as well as the non-significant relationship between training and both satisfaction and intention to quit, our data suggest that the aforementioned facilitating conditions may be insufficient to accomplish this goal, though we have no specific details in our data about the quality of the feedback or training.”

    “More importantly, when providers do not perceive the value of these electronic aids to their practice, they might become dissatisfied with their work environment, and potentially seek work elsewhere altogether.”

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