Monday, April 9, 2012

As in the Pharmacy, Message Fatigue Can Be A Key Root Cause of EMR Errors in the Doctor's Office

Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals 

The International Journal of Medical Informatics in its April 2012 issue has cited a study that I believe is something that practicing pharmacists (in a variety of clinical settings, including retail and hospital), have known for a long time:  the more messages the human brain must handle per hour, the less meaningful the individual messages will be because of a “fatigue factor”.   Indeed, I believe it is one of the key “root causes” of medication errors which get through to the patient despite all of the safety-checks in the pharmacy. Certainly, most retail pharmacy chains modify downward the level of alerts so that pharmacists are not unnecessarily distracted with false-positive warnings as they attempt to do their jobs----these system policies allow only the critical alerts or drug interactions to be pushed to the pharmacist for a traceable response to either override the message or provide an alternate response.   
As physicians are moving into a more fully automated practice of medicine, this phenomenon must also extend to them, by definition.   
The study was supported by the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice.  Dr. Allisa Russ, PhD, of the Richard L. Roudebush VA Medical Center in Indianapolis noted that some alerts don't give enough information and others contradict common clinical practice. 
This link will take you to a summary of the study from MedPage Today:  www.medpagetoday.com/PracticeManagement/InformationTechnology/32006
The key EMR warning of the study is this:  “Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as (electronic medical record) systems expand beyond single hospitals and share more data."

Terri is the founder of Cambria Health Advisory Professionals.  Among her current clients:  a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders. a small special needs health plan as a 5 Star Consultant, and several other health related clients.  The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Health Thought Leader colleagues.   Terri has had a varied career in health related settings including:  9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago.   She has both a BS and a PharmD in Pharmacy and an MBA.