Readers Write: Help on the Way for Clinician Work Fatigue with Drug Interactions?

Help on the Way for Clinician Work Fatigue with Drug Interactions?
By Helen Figge, RPh, PharmD

Clinicians are increasingly using an electronic health record (EHR) to enter prescriptions via a computer. Increased utilization of computerized medication order entry is being driven in part by the Meaningful Use program, which includes incentives for the adoption and meaningful use of certified electronic health records for eligible clinicians in both the Medicare and Medicaid programs.

Electronic prescribing is an integral component of the Meaningful Use program. Regardless of whether the prescriber elects to print or electronically transmit the prescription, the prescriber’s EHR can apply a series of edits to check for potential errors that could be harmful to the patient.

Some EHRs display all edits with equal significance. Hence, clinicians are presented with a stream of low-priority or irrelevant edits mixed in with occasional high-value edits. The consequences of this type of presentation are very serious because clinicians become overwhelmed and frustrated with the continuous presentation of low-priority nuisance alerts – hence clinician “alert fatigue.”

Because alert fatigue threatens to potentially jeopardize the entire concept of improving patient safety, the Office of the National Coordinator for Health Information Technology (ONCHIT) awarded a grant to the RAND Corporation and Harvard/Partners HealthCare in collaboration with UCLA to study the problem and develop a solution. The approach taken by the study group was to identify a critical set of interactions that should be implemented universally.

Thirty-one high risk drug-drug interactions were reviewed and a final list of 15 interactions was adopted. The study group considered the final set of 15 interaction pairs to be a starter set that should be identified in all commercial products as high severity because they have high potential for patient harm and are contraindicated for co-administration. The list might not represent all high-severity interactions, so additional research will be needed in this area, but it’s a proactive start.

Deployment of these 15 interaction sets in EHRs as high risk, along with the elimination of clinically irrelevant edits, could greatly reduce the burden of alert fatigue that clinicians overwhelmingly feel in their day-to-day encounters with the technologies. However, the actual commercial implementation of this approach has not been successfully accomplished due to legal issues, particularly due to concerns among database and EHR vendors about liability.

The overarching question to be answered is funding and exact methodology for moving this effort forward at the national level, which has not been identified. Furthermore, it has not been determined whether the database should be maintained by a private entity or by a public agency such as FDA.

But it is progress in the war against what really true drug integration is and what is just a cautionary listing for liability’s sake.

Helen Figge is advisor, clinical operations and strategies, for VRAI Transformation.