It turns out that electronic medical test results are a lot like email: many get lost in the digital shuffle.
Researchers from the Michael E. DeBakey Veterans Affairs Medical Center in Houston conducted a survey of 2,590 primary care practitioners and found that a third reported missing alerts about test results from a electronic health record notification system designed to inform them when a patient has abnormal test results.
In the study published in the Journal of the American Medical Association (JAMA), the scientists reported that the doctors reported getting about 63 alerts a day, which could be leading to a notification fatigue that lets important results that require the physician’s immediate attention to slip through the cracks. Almost 87% of the practitioners said the number of alerts they received was excessive, 69.6% reported getting more alerts than they could effectively manage and 55.6% said the way the electronic health records notification system is set up makes it possible for them to miss test results.
That’s not how it was supposed to be. As iPads replace doctors’ folders and health systems use text messaging to track disease, the massive amount of information that digital systems can process is, in theory, supposed to make medical care easier to deliver and more efficient. But there can be such as thing as too much of a good thing.
The researchers conclude that the systems make doctors vulnerable to information overload. “If you’re getting 100 emails a day, you are bound to miss a few. I study this area and I still sometimes miss emails. We have good intentions, but sometimes getting too many can be a problem,” says study author Dr. Hardeep Singh of the DeBakey VA Medical Center.
Still, that may be a small price to pay for the wider benefits of digitizing medical files and results so doctors stay on top of their overall workload. In August, TIME looked at the role of iPads in medical facilities as a way to improve care:
As clerical loads increased, “something had to give, and that was always face time with patients,” says Dr. Bhakti Patel, a former chief resident in the University of Chicago’s internal-medicine program. In fall 2010, she helped launch a pilot project in Chicago to see if the iPad could improve working conditions and patient care. The experiment was so successful that all internal-medicine residents at the university now get iPads when they begin the program. Johns Hopkins’ internal-medicine program adopted the same policy in 2011. Medical schools at Yale and Stanford now have paperless, iPad-based curriculums. “You’ll want an iPad just so you can wear this” is the slogan for one of the new lab coats designed with large pockets to accommodate tablet computers.
The authors of the current study agree, but say there are a few ways electronic record systems can be improved to maintain their effectiveness. “I think using electronic communication is the way to go, but the health care system is fairly complex. This needs a multifaceted approach,” says Singh.
Specifically, he and his research team have previously outlined eight aspect of the electronic health care system that could be enhanced. Designing easier ways for physicians to access the information, and properly training personnel to use the systems effectively could help, for example. “We all want the alerts to look like our smartphones and apple products, but the interface is not always clear and you can miss results quite easily,” says Singh.
Even if hospitals and doctors have alert systems set up, the notifications aren’t helpful if there isn’t an established system for determining who is responsible for taking action when an abnormal test result appears. Otherwise, critical opportunities for helping patients may be missed — much in the same way that receiving an email addressed to several other recipients leads everyone to assume someone else will respond. For instance, Singh says there should be a process by which doctors can forward the alerts on to another individual when they are on vacation or are leaving a hospital. And if the patient is being treated by a primary care physician, and referred to a specialist for more in-depth testing, both doctors should be in touch about how to follow-up on the test results Having firmer and detailed policies detailing how these responses should occur should address any confusion.
He also stresses that patients have a responsibility to follow-up and be engaged in their care. “We need to dispel the myth of ‘no news is good news from the doctor,'” says Singh. “In fact, if patients don’t hear back about the results, they should actively seek them out.” There’s a small chance that the results were lost in the deluge of information your doctor receives every day.