The 30-Second Exercise: Counting the Alert Override Burden No One Tracks

Count to 30. One Mississippi, two Mississippi. That's how long it takes to open a notification, recognize it changes nothing you're about to do, and dismiss it.

Now do that 40 times before lunch.

In this episode, Dr. Kevin Halow, MD, MBA, does the counting no one else in clinical medicine does and shows where all those 30-second units are hiding inside your day.

The research is more specific than most physicians realize. A systematic review of 23 studies published in the Journal of the American Medical Informatics Association found physician alert override rates ranging from 46% to 96%. Nanji and colleagues reported a 73% override rate for medication-related alerts alone at a large academic outpatient center. The AMA's most recent national data puts physicians at roughly 13 hours a week of indirect patient care — and alert review lives inside that number, uncounted, with no line item of its own.

The cost isn't only time. It's clinical decision fatigue, compounding silently across every dismissal, every day, for which no one is keeping score.

Dr. Halow also walks through the design principle behind HCO Practice HQ: role-aware routing that treats physician attention as the finite, valuable resource it actually is.

Topics in this episode: why physician alert override rates reach 96%, how 40 daily 30-second dismissals compound into structural clinical decision fatigue, what the AMA data on indirect patient care actually contains, and what role-aware routing looks like in practice.

The ClinicianCore waitlist is open at cliniciancore.com/waitlist.

About the ClinicianCore Podcast

Hosted by Dr. Kevin Halow, the ClinicianCore Podcast explores unified clinical communication, physician burnout reduction, HIPAA-compliant collaboration, and the real impact of AI in healthcare.

New episodes are released every Monday at 1 PM EST.

If you’re a healthcare leader, physician, administrator, or innovator committed to improving clinical efficiency and restoring clarity to care delivery, this podcast is for you.

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Learn more about ClinicianCore and our mission to strengthen clinician collaboration at:
https://cliniciancore.com/

Connect with Dr. Kevin Halow
LinkedIn: https://www.linkedin.com/in/kevin-halow-md/

Transcript

SPEAKER_00 0:00

Try something with me right now. Count to thirty. You know, like 1001, 1002. You can do Mississippi's if you want. One Mississippi, two Mississippi. Do it slowly. Like you're actually reading something or deciding on something and then moving on. That's it. That's the whole unit. Open a notification, read it, recognize it's nothing you need to act on. Close it. 30 seconds. Sometimes less. Maybe it's closer to two minutes if the alert is dense enough to need a second look or maybe even a third. Now, do that 40 times before lunch. Nobody hands you a form for this. It doesn't show up on your schedule. Your RBUs don't count it. It's not on your end-of-year review. Your practice tracks your patient volume down to the minute, but no one is tracking this. And I've come to think that's exactly the problem. Not the 30 seconds themselves, but the fact that no one anywhere in the system is counting them. Hi, I'm Dr. Kevin Hallow, surgeon, veteran, co-founder, and chief medical officer of Clinician Corps. Today I want to actually do the counting no one else is doing and show you where all of those uncounted 30-second pieces of your day, every small cognitive interruption that is driving your clinical decision fatigue, I want to show you where all those 30-second pieces are hiding. Let's start with what we actually know because the numbers here are better documented than most physicians realize. A systematic review in the Journal of the American Medical Informatics Association, covering 23 studies, found that physicians override clinical decision support alerts at a rate between 46% and 96%, depending on the type of alert. Nanji and colleagues studied a large academic outpatient center over three years and found a 73% override rate specifically for medication-related alerts. Think on that for a second. On a bad alert type, nearly everything that pings you gets dismissed because nearly none of it changes what you actually do next. Each one of those pings is a cognitive interruption, and each dismissal costs you somewhere between 30 seconds and two minutes of attention that you'll never get back and for which you will never get credit. Multiply a conservative estimate of that across a single working day, and you're not talking about an inconvenience anymore. You're talking about a second uncounted job that you're doing in the margins of your real one and you're not getting paid for it. Let me make this concrete because abstractions are easy to dismiss and specifics are not. Let me give you a few examples. We're talking about the duplicate allergy warning that fires for the third time this week on the same patient because the system doesn't remember you already addressed it. It's the routine refill request that reads exactly like an urgent one. So you have to open it to find out which one it is. It's the portal message about a copay question that landed in your queue instead of your front desk office staff's queue. It's the scheduling conflict flag that has nothing to do with your clinical judgment at all, but still for some reason needs your eyes on it before it's clear. None of those on their own is a big ask. That's exactly why nobody's counting them. Each one is a small cognitive interruption, unworthy of complaint on its own, and there are enough of them, but by the time you notice the pattern, the day's already gone. Here's the distinction I actually want to leave with you. It's not really about how many minutes this adds up to, though it does add up. It's about the fact that this is invisible labor. No one schedules it, nobody staffs for it, nobody asks you about it, and you are not getting paid for it. The AMA's most recent national data found physicians report roughly 13 hours a week, of what gets classified as indirect patient care. You know, order entry, documentation, test result interpretation, and everything adjacent to it. Alert review lives inside that number, uncountered as its own line item, folded into a category broad enough that its true side never gets named. See, you experience every one of those 30-second units individually, one at a time, all day. But the system that generates them only ever sees the aggregate. If it sees it at all, which it probably doesn't. That mismatch between what you feel and what gets measured is exactly why this problem has been able to hide in plain sight for as long as it has. Left unnamed, it doesn't just cost time. It compounds into a real clinically silent form of clinical decision fatigue that affects you every single day in your practice. So what does it actually look like to count this instead of just absorbing it? Well, it starts with a basic premise. Not every notification that reaches you deserves to reach you. A system that's actually counting would ask, before it ever interrupts you, whether this specific alert for this specific patient at this specific moment genuinely needs your attention, or whether it's routine enough to be handled, batched, or routed to someone else entirely. That's the design principle behind HCO practice HQ, the organizational communication module inside clinician core. We're all aware, urgency-scored routing that treats your attention as the finite valuable resource it actually is. Instead of assuming that every message earns an equal claim on it. Fewer cognitive interruptions, less clinical decision fatigue, more of your day actually counted as your day. Here's what I want you to take with you from this podcast. The next time that you catch yourself dismissing another alert that changed nothing, I want you to notice it. Really notice it. Because that 30 seconds that nobody counts 40 times a day is your day. That time belongs to you. You did not train for over a decade to spend a meaningful fraction of your working life absorbing cognitive interruption and clinical decision fatigue for which nobody is keeping score. Neither did I. The fix is not asking you to move faster through the noise, it's building a system that finally starts counting. Clinician Core's HCO Practice HQ is there beside you during your day to filter the noise from your practice so that you can concentrate on being a physician. If you want to see what that looks like, we're in soft launch now ahead of our full September release. The wait list is open at cliniciancore.comslash wait list. Visit our website and sign up. That is our podcast for today. I'm Dr. Kevin Hallow, co founder and chief medical officer of Clinician Corps. You can go and take care of your patients. We'll do the counting for you. Thanks for listening.