Physicians Spend 1 Hour on EHR Alerts per Day

Nicola M. Parry, DVM

March 16, 2016

Findings from a new study show that some physicians receive more than 100 notifications per day via electronic health record (EHR)-based inboxes, and dealing with this electronic burden requires more than an hour every day.

"Primary care providers (PCPs) received an overall mean of 76.9 notifications per day," write Daniel R. Murphy, MD, from Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, and colleagues, stressing that some PCPs received as many as 113.5 notifications per day.

The results of their study appear in a research letter published online March 14 in JAMA Internal Medicine.

Excessive EHR-based notifications can overburden physicians and lead to potentially disastrous consequences. Unmanageable numbers of alerts not only make it difficult for physicians to filter out important information but also increase the chances that physicians will miss patients' test results.

"Information overload is of emerging concern because new types of notifications and 'FYI' (for your information) messages can be easily created in the EHR (vs in a paper-based system)," the authors write. EHR-based notifications typically include messages from other healthcare providers, responses to referrals, requests for medication refills, and test results.

Dr Murphy and colleagues therefore set out to quantify the notifications that physicians received via inboxes of commercial EHRs to estimate their burden.

They evaluated the electronic logs of 276,207 notifications received from January 1 through June 30, 2015, by 92 physicians at three large practices (one multispecialty and two primary care practices) in Texas.

Overall, 46 PCPs at the three practices received an average of 76.9 total notifications per day, 15.5 (20.2%) of which were related to test results.

In contrast, 46 specialists at the multispecialty practice received significantly fewer notifications than PCPs at the same site: an average of 29.1 total notifications (P < .001), including 10.4 that were related to test results (P = .03).

The data also showed a significant negative correlation between time worked and normalized daily total notifications received (P = .008), suggesting that compared with physicians who worked full time, those who worked part time received more notifications for the amount of time they spent in the clinic.

In addition to the types of messages typically received, physicians in this study also received messages directly from patients and pharmacies.

According to the authors, a previous study demonstrated that "PCPs spent a mean of 49 minutes processing 56.4 notifications of comparable content each day," which equates to an average of 52 seconds per notification.

"Extrapolating this finding to commercial EHRs suggests that physicians spend an estimated 66.8 minutes per day processing notifications, which likely adds a substantial burden to their workday," the authors note.

They also emphasize that physicians' actual burden and required cognitive effort are probably even greater than this because each individual notification may contain multiple data points that physicians must process.

"Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed," the authors conclude.

This study was funded by the Agency for Healthcare Research and Quality and partially funded by the Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness, and Safety. Dr Murphy is also supported by an Agency for Healthcare Research and Quality Mentored Career Development Award. One coauthor is supported by grants from the Veteran Affairs Health Services Research and Development Service and by the Veterans Affairs National Center for Patient Safety. The other authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online March 14, 2016. Full text

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