NCPA - National Center for Policy Analysis


February 16, 2009

Doctors often override electronic medication safety alerts and rely instead on their own judgment when prescribing drugs for patients, which suggests that physicians find the alerts more annoying than helpful, according to a new study in the Archives of Internal Medicine.

Researchers looked at 3.5 million electronic prescriptions generated by 2,872 doctors at community-based outpatient practices in Massachusetts, New Jersey and Pennsylvania and at the medication alerts associated with those prescriptions.  They found:

  • About one in 15 prescription orders produced an alert for drug interaction or drug allergy.
  • Of those 233,537 alerts, 98.6 percent were for a potential interaction with a drug being taken by a patient.
  • Doctors overrode more than 90 percent of the drug interactions and 77 percent of the drug allergy alerts.

The high override rate suggests major changes are needed to improve the usefulness of electronic medication alerts, said the researchers.  "Too many alerts are generated for unlikely events, which could lead to alert fatigue," says the study's first author, Dr. Thomas Isaac of the Beth Israel Deaconess Medical Center in Boston.

Isaac and colleagues suggested several ways to improve medication safety alerts, including:

  • Reclassifying the severity of alerts, especially those that are frequently overridden.
  • Providing an option for doctors to suppress alerts for medications a patient has already received.
  • Customizing the alerts for a physician's specialty.

Sources:  Robert Preidt, "Docs Override Most Electronic Drug Warnings," MedlinePlus, February 12, 2009, and Thomas Isaac, et al., "Overrides of Medication Alerts in Ambulatory Care," Archives of Internal Medicine, Vol. 169, No. 3, pages 305-311.

For study abstract:


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