Appl Clin Inform 2020; 11(01): 001-012
DOI: 10.1055/s-0039-3402715
Georg Thieme Verlag KG Stuttgart · New York

Reducing Alert Burden in Electronic Health Records: State of the Art Recommendations from Four Health Systems

John D. McGreevey III
1   Office of the CMIO, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
2   Section of Hospital Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Colleen P. Mallozzi
1   Office of the CMIO, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
Randa M. Perkins
3   H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
Eric Shelov
4   Division of General Pediatrics, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Richard Schreiber
5   Physician Informatics and Department of Medicine, Geisinger Health System, Geisinger Holy Spirit, Camp Hill, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

19 August 2019

12 November 2019

Publication Date:
01 January 2020 (online)


Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan.

Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts.

Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human–computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians.

Results The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship.

Conclusion Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.

Protection of Human and Animal Subjects

No human subjects were involved in this project and Institutional Review Board approval was not required.