CYA Alerts Not Working Well

In order to supposedly help doctors from making mistakes:

96% of hospitals that use computerized physician order entry (CPOE) systems also have clinical decision support (CDS) tools. The CDS tool enables prescribers to access real-time patient data, ideally resulting in enhanced patient safety and medication accuracy. CDS can also alert the prescriber about potential patient warnings to prevent errors and additional adverse drug events from happening.

While both systems aim to aid the prescriber and lower patient harm, both have unintended consequences, such as alert fatigue, missed alerts, and ultimately clinician burnout.

This is the problem with the wrong people being in charge of EHRs. No one wants responsibility for anything going wrong so these damn things send out alerts for everything. After a while, the doctor doesn’t give a crap anymore and just stops checking. The EHR people don’t care because they can always go back and say, “The system alerted you” if something happens and so they are happy. But doctors are miserable.

Let’s just call these things what they are and that is COVER YOUR ASS (CYA) alerts but they are only there to cover the ass for the EHR system and the hospital and no one else.

Because there was minimal improvement against nuisance orders, but modest improvement overall and for fatal orders, researchers posited that too many alerts had been turned on. And too many alerts typically result in alert fatigue and clinician burnout.

Too many alerts makes a doctor insane. It’s pretty simple.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “CYA Alerts Not Working Well

  1. arthur gindin
    July 14, 2020 at 2:41 pm

    ‘SOMETIMES” consequences are self-defeating

  2. Gary Gaddis
    July 13, 2020 at 4:31 pm

    Dear Doug and other readers:

    I have a better name for these alerts.
    I call them “Tag, you’re it” alerts, because once you click on them, even if you have not read them, the system treats the event as if reading occurred, with no regard for how many alerts have been “acknowledged” and in what time period.

    If we are going to be held “responsible” for these alerts and their content, then any fair adjudication of our response MUST include how many other alerts have been flashed at us, and some indication of the level of concern the alert can reasonably be expected to cause. As an Epic user, I could give many “for-instances”.

    Just who comes up with these abortions of reasonable expectations, anyhow? I don’t use the inflammatory term “abortion” lightly.

  3. Jennifer Hollywood
    July 13, 2020 at 9:08 am

    I currently get an alert on almost every drug I prescribe. It is now including dye colors such as blue or yellow in the drug reactions.

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