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Toward Electronic Medical Record Alerts That Consume Less Physician Time

Clement J. McDonald, MD1
[+] Author Affiliations
1Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health (NIH), US Department of Health & Human Services (HHS), Bethesda, Maryland
JAMA Intern Med. 2013;173(18):1755-1756. doi:10.1001/jamainternmed.2013.9332.
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To the Editor In a series of beautiful studies, Singh and colleagues have described the nature and quantified the effects of electronic medical record (EMR) alerts on care process. Primary care providers (PCPs) report in a survey instrument that almost half of the asynchronous (e-mail–like) alerts from the Department of Veterans Affairs (VA’s) EMR were irrelevant to patient care, excessive in number,1 and more than they could manage, making it possible to miss test results. In another study, they observed that PCPs received a median of 63 such alerts requiring 50 minutes of their time per clinic day,2 not counting synchronous alerts about, for example, drug interactions, that are even less specific.3 The VA’s EMR probably has the most sophisticated tools for minimizing abnormal test alerts in the market. Radiologists, while reading their studies, inform the PCPs about important abnormal findings through alerts, and PCPs can suppress some kinds of alerts at will. “Excessive” alerts are a problem with almost all EMRs4 owing in part to well-intentioned policies that require special attention for every possible signal that might indicate a problem regardless of its specificity and to the use of alerts for administrative purposes. However, if everything is important, then nothing is.5


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October 14, 2013
Hardeep Singh, MD, MPH; Dean F. Sittig, PhD
1Department of Medicine, Baylor College of Medicine, Houston VA Health Services Research and Development (HSR&D) Center of Excellence Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, and the Section of Health Services Research, Houston, Texas
2University of Texas School of Biomedical Informatics and the University of Texas–Memorial Hermann Center for Healthcare Quality and Safety, Houston
JAMA Intern Med. 2013;173(18):1756. doi:10.1001/jamainternmed.2013.9317.
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