A late attempt to involve end users in the design of medication-related alerts: survey study

Melissa Therese Baysari*, Wu Yi Zheng, Bethany Van Dort, Hannah Reid-Anderson, Mihaela Gronski, Eliza Kenny

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
26 Downloads (Pure)


Background: When users of electronic medical records (EMRs) are presented with large numbers of irrelevant computerized alerts, they experience alert fatigue, begin to ignore alert information, and override alerts without processing or heeding alert recommendations. Anecdotally, doctors at our study site were dissatisfied with the medication-related alerts being generated, both in terms of volume being experienced and clinical relevance. Objective: This study aimed to involve end users in the redesign of medication-related alerts in a hospital EMR, 4 years post implementation. Methods: This work was undertaken at a private not-for-profit teaching hospital in Sydney, Australia. Since EMR implementation in 2015, the organization elected to implement all medication-related alert types available in the system for prescribers: allergy and intolerance alerts, therapeutic duplication alerts, pregnancy alerts, and drug-drug interaction alerts. The EMR included no medication administration alerts for nurses. To obtain feedback on current alerts and suggestions for redesign, a Web-based survey was distributed to all doctors and nurses at the site via hospital mailing lists. Results: Despite a general dissatisfaction with alerts, very few end users completed the survey. In total, only 3.37% (36/1066) of doctors and 14.5% (60/411) of nurses took part. Approximately 90% (30/33) of doctors who responded held the view that too many alerts were triggered in the EMR. Doctors suggested that most alerts be removed and that alerts be more specific and less sensitive. In contrast, 97% (58/60) of the nurse respondents indicated that they would like to receive medication administration alerts in the EMR. Most nurses indicated that they would like to receive all the alert types available at all severity levels. Conclusions: Attempting to engage with end users several years post implementation was challenging. Involving users so late in the implementation process may lead to clinicians viewing the provision of feedback to be futile. Seeking user feedback on usefulness, volume, and design of alerts is extremely valuable; however, we suggest this is undertaken early, preferably before system implementation.

Original languageEnglish
Article numbere14855
Pages (from-to)1-7
Number of pages7
JournalJournal of Medical Internet Research
Issue number3
Publication statusPublished - 13 Mar 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • alert fatigue
  • alerting
  • clinical decision support
  • hospital information systems
  • medication alert systems


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