Epic Insights

Reducing Alert Fatigue

The Impact of Misconfigured Alerts

EHR system alerts are critical to employ, but if overused or misconfigured, they can produce the opposite of intended effects.

When staff see system alerts at frequencies causing them to bypass information or steps, they experience Alert Fatigue.

For providers already overwhelmed with administrative system requirements and documentation, extraneous alerts contribute to levels of frustration, dissatisfaction, and burnout.

The Challenge

As Healthcare Triangle, Inc. (HCTI) began rolling Epic Community Connect out to a client’s Ambulatory practice, it became quickly evident that many of the decision support tools offered in the enterprise standard scope package were broken, incomplete, and/or misconfigured.

Transitioning from a longstanding EHR to Epic, key features were being reviewed and put under the microscope for comparison. If unaddressed, these issues would have caused rampant inefficiency and dissatisfaction in the Community clinics.

The Work

After detailed evaluation, ~30 unique Best Practice Alerts were identified with inherent problems needing to be addressed.

To mitigate rapidly for the in- flight Connect implementations, HCTI’s Epic team placed restrictors on the BPAs, so the new sites would not be impacted until the features were working as desired.

The team then set to work reviewing alert criteria piece-by-piece, cataloguing each item that was broken, missing, or misleading. A Clinical Decision Support (CDS) workgroup was then established with the organization’s Enterprise Epic team, becoming responsible for review, desired functions, and corrective actions.

As decisions within the workgroup were made, corrections were executed, communicated, and monitored within an iterative LEAN approach.

Ultimately, each BPA required some form of action in order to improve. A few were retired completely, while most were corrected and re-released for both Enterprise and Community Connect Epic users.

Mechanisms Leveraged:

  • Epic Cubes Data + Direct System Analysis
  • Workgroup Formation + Stakeholder Review
  • Rapid Improvement Cycles


Based on preliminary data following the initiative, the number of alert instances firing had been reduced by 40%. When one did fire, it was now meaningful and actionable.

In the weeks after the execution, comments began making their way back to the Epic Enterprise team, thanking them for the work they had done and verbalizing how much more relevant and automated the “dreaded pop-ups” had become.

HCTI had been able to identify, analyze, and execute all corrective measures, requiring only input from key clinical stakeholders.


  • The Epic and IT teams had taken giant steps forward with their customer base
  • The Community Connect program ensured their customers would receive a top-notch product
  • The IT workforce had not had to invest in any significant lift

Improvements Executed

  • 82% of the alerts were enhanced with automation to reduce clicks
  • Triggers (open chart, enter orders, etc.,) were removed for 50% of the alerts to reduce frequency and redundancy of display
  • Outdated SmartSets were replaced or optimized
  • Instructions and contextual information were enhanced
  • Default actions and options available were improved

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...the number of alert instances firing had been reduced by 40%. When one does fire, it was now meaningful and actionable.

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