Imagine you are a final-year critical care fellow on call – four years of medical school, three years of internal medicine residency, and one year of fellowship (with one to go). One night, you are suddenly awoken by your trusty pager at 3 a.m. for a rapid response. You rush to the patient’s room and successfully stabilize them (or so you thought), closing an annoying false alarm pop-up on the patient’s computer screen as usual. You block out the persistent ringing and hums of the hospital, journeying back to your dingy call room to get a little more rest. Seems routine, right?
Not quite, you just unknowingly ignored the patient’s abnormal vitals plummeting in the wrong direction only because you had gotten accustomed to the constant false alarms in the electronic health system.
Though thankfully less severe, such situations are far too common, with alarm fatigue confusing overworked healthcare providers. According to a study publish in Wiley Online Library, a “one-unit increase in the alarm fatigue level” of ICU nurses increased the likelihood of medical error by 0.263 units (p < .001) [1].
The computerization of healthcare has placed an unnecessary burden on the healthcare system and providers. Though the modernization of medicine and the rise of human-computer interaction in the healthcare system have provided for improved training and educational experiences for students, it has also come with its flaws. Healthcare teams and patient outcomes have been negatively affected by such integration of technology, which has made it more difficult to navigate the alarm fatigue, electronic health records, and added administrative tasks.
Alarm Fatigue
Among healthcare professionals, alarms are just a normal part of the job. But this is exactly the sentiment that is detrimental to the safety and health of patients — it is assumed that because providers have encountered technology-caused false alarms previously, the technology is once again malfunctioning or raising alarms about unconcerning and unremarkable findings [2]. This is exactly the opposite of an alarm’s purpose, which is made to only sound when patients need to be cared for immediately.
In an interview with the Institute for Healthcare Improvement, Robert Watcher, MD, an internist based in San Francisco, Ca., shared that nurses can better discern whether patients are in danger if there is no usual sound of alarms ringing as opposed to when they are [3]. These alarms ringing are due to the use of insufficient computerized systems that raise unnecessary and excess alarms, causing healthcare professionals to not only ignore the alarms, but also treat them as malfunctioning technology.
Due to the numerous amount of incessantly ringing, unconcerning computerized alarms and pop-ups, real alarms that require immediate action are often ignored and perceived to be routine, understandably compromising patient care. Though not a novel issue, much research is still being conducted to find the best way to address alarm fatigue and ensure the safety of patients by eliminating unnecessary alarms that healthcare workers ignore and amplifying critical alarms that indicate danger.
A cornerstone of this effort to minimize medical error from alarm fatigue is to improve and refine computerized systems to not raise false alarms and ensure that alarms initiated actually indicate a patient is in danger. Including healthcare workers in the research and development of improved medical systems will better patient outcomes as those actually involved in treating patients will be able to tailor systems to their liking. These unnecessary alerts that healthcare workers are bombarded with are not only harmful on their own, but also make it more likely that healthcare providers will ignore the next alarm.
Electronic Health Records
In addition to alarm fatigue and difficulties that directly involve patients, the burden of current systems of human-computer interaction also manifests in the various administrative tasks of doctors, including charting in patients’ electronic health records (EHRs) [4].
Though this computerization of health records has allowed for ease of access for patients and reduced errors like duplication of tests, the process of constructing and updating EHRs are extremely tedious for doctors and advanced practice providers.
In a 2018 survey conducted by the Harris Poll, one-third of doctors said they are unsatisfied with the current system of EHRs and think they are “clunky, poorly designed, hard to navigate, and cluttered with useless detail” added to meet documentation requirements [5]. Furthermore, it is harder for providers to access meaningful information which becomes buried in this record. This is partly due to the way in which EHRs were created: to generate “clinical revenues.”
EHRs are not created to optimize doctor-patient interactions, maximize face-to-face interaction, improve overall care, or reduce costs. Instead, they are vital for generating the maximum amount of revenue which results from detailed billing and documentation.
Healthcare providers are obligated to utilize EHRs, and although they have many upsides, the current system does not allow for optimal patient care, hurts the doctor-patient relationship, and places an unnecessary burden on doctors and other providers.
And although doctors can hire medical assistants or scribes to assist with this process, the costs are high for private practice owners. Because the American healthcare system does not incentivize better care, the current EHR design only allows for rudimentary actions which make the process extremely tedious and overcomplicated.
Added Administrative Tasks
From clicking out of pop-ups on patient health records to completing unnecessarily extensive documentation required through computerized systems, the computerization of healthcare has definitely increased administrative tasks for physicians. In a hospital-wide survey of 1,774 physicians conducted in Massachusetts General Hospital, 66% of respondents said that the increased administrative burden complicates their ability to provide “high quality care” and those who spent more time tending to administrative duties were less satisfied and more prone to burnout [6].
Physical Medicine and Rehabilitation, Critical Care, Internal Medicine, Nephrology, Neurology, Oncology, and Family Medicine have the most hours spent on administrative duties (ranging from 17-19 hours), according to Billing Paradise [7]. If the extensive administrative burden placed on physicians and the larger healthcare team is not addressed, the understaffing of physicians – particularly those in primary care – will not only take a toll on the healthcare system, but undoubtedly compromise patient outcomes and prolong treatment of urgent conditions.
There is currently no viable solution to the issues of human-computer interaction in the healthcare system, but it is evident that the system needs to be modified to decrease the burden on doctors, pharmacists, and other advanced practice providers to maximize patient interaction and meaningful visits. This change starts with involving members of the healthcare team into the development of a system that first and foremost, aims to serve patients and doctors – just like the overworked critical care fellow struggling to stay awake.
1. Gündoğan, Erdağı Oral, G., Semra. (2023, August 23). The effects of alarm fatigue on the tendency to ... - Wiley Online Library. The effects of alarm fatigue on the tendency to make medical errors in nurses working in intensive care units. https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.12969.
2. State finds hundreds of medication errors linked to healthcare. (2017, April 10). Healthcare IT News. https://www.healthcareitnews.com/news/state-finds-hundreds-medication-errors-linked-healthcare-technology#:~:text=But%20the%20introduction%20of%20technology,content%20(23%20percent).%E2%80%9D.
3. Open School, I. (2017, October 6). What are the dangers of alert fatigue?. YouTube. https://www.youtube.com/watch?v=juitFz2eJHc.
4. Woo, Bacon, M., Olivia. (n.d.). Alarm fatigue - making healthcare SAFER III: A critical analysis of Existing and Emerging Patient Safety Practices. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices. https://www.ncbi.nlm.nih.gov/books/NBK555522/.
5. Blumenthal, D. (2018, December 13). The Electronic Health Record Problem. Commonwealth Fund. https://www.commonwealthfund.org/blog/2018/electronic-health-record-problem#:~:text=Two%2Dthirds%20of%20primary%20care,meet%20the%20needs%20of%20users.
6. Rao SK;Kimball AB;Lehrhoff SR;Hidrue MK;Colton DG;Ferris TG;Torchiana DF; (2017, February). The impact of administrative burden on academic physicians: Results of a hospital-wide physician survey. Academic medicine : journal of the Association of American Medical Colleges. https://pubmed.ncbi.nlm.nih.gov/28121687/.
7. Regulsky, E. (2023, June 29). Hours spent on administrative tasks across 23 specialties. BillingParadise. https://www.billingparadise.com/blog/23-physician-specialties-and-the-number-of-hours-spent-on-paperwork/#:~:text=Cardiologists%2C%20psychiatrists%2C%20and%20diabetes%20and,coordination%20with%20other%20healthcare%20professionals.