The Alert System That Was Never Designed With Physicians in Mind

I was mid-fem-pop bypass, everything running smoothly. Flow established, team locked in, music playing off my phone to keep the room steady. Then the audio kept cutting out. Not once. Not twice. Over and over through the case.

When I finally glanced at the screen, it wasn’t a critical alert. It was a refill request that could have waited until afternoon clinic. A duplicate allergy warning I’d already cleared twice this week. A co‑pay notification I have no idea why I received. And buried underneath all that noise, a stat potassium on my next surgical patient — the one thing that actually mattered.

In my new today's episode of The Connected Practice, I trace where your alert system actually came from: a 2011 certification requirement that asked vendors to make an alert fire, not to make it fire at the right moment for the right person. That single choice is the ancestor of nearly every interruption in your day.

The exhaustion you feel isn't a discipline failing. It's traceable engineering. Which means it's fixable.

Soft launch is open now ahead of the full September release.
 Download Now: https://cliniciancore.com/app-download 

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/

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LinkedIn: https://www.linkedin.com/in/kevin-halow-md/

Transcript

SPEAKER_00 0:00

I want to take you back to another frustrating day in my life as a surgeon. I was doing a femme pop bypass. Things were going really well. Spotify was playing on a speaker from my phone. I mean, it looked like the result would be really good. I I should be excited, right? But the music was being continuously interrupted with alerts from my phone. Not once, not twice, but countless times throughout the case. So annoying. I mean, how do you make that stop? Well, after I finished the case, I glanced at my phone to see what I was missing. One was a refill request that could have waited until I reached the office. Another was a duplicate allergy alert that I had already acknowledged twice that week. A third was a message from our practice portal about a copay for a patient. I have no idea why that was routed to me. Ironically, buried under all of that was the stat potassium level on the next surgical patient in my line. That actually mattered. Nothing about the way that information reached me told me which one was which. They all looked the same. They all sounded the same. They all demanded the same 30 seconds of my attention with the same visual weight. That's not a physician's problem. That's not an attention problem. That's a design problem. And it's one almost nobody built on purpose. It's one we all just inherited. Hello again. I am Dr. Kevin Hallow, surgeon, veteran, co-founder, and chief medical officer of Clinician Corps. Today I want to walk you through something most physicians have never been told: the origins of your alert system, why it was built the way it was, and why the exhaustion you feel from these alerts is not a personal feeling, but an engineering choice that someone else made for a reason that had almost nothing to do with you as a physician. Here's what most of us were never told in training, because none of us were in the actual meeting room when it happened. We were too busy taking care of patients. In 2009, the federal government passed the High Tech Act. H-I-T-E-C-H, the High Tech Act. Buried inside it was a program called Meaningful Use. Billions of dollars in incentive payments to push physicians onto certified electronic health records. Stage one of that program, which took effect in 2011, required every certified EHR to include drug-to-drug and drug-to-allergy interaction checking, plus at least one clinical decision support rule before practice could collect a dime of that incentive money. You're probably thinking, what? Yep, that's right. The requirement was not to build an alert system that physicians find useful. The requirement was to implement at least one rule, pass a certification, collect the incentive. So the vendors built exactly what they were asked to build as fast as they could for as many customers as possible to a testing standard, not a workflow standard. And when a certification body is grading whether an alert fires, not whether it fires at the right moment for the right person at the right threshold, the safest engineering decision every time is to make it fire more. Because a missed alert is a liability exposure for the HR company. And a lowing alert is just another typical Tuesday in a physician's life. That single design choice, optimized for legal defensibility, not clinical judgment, is the ancestor of almost every alert that interrupts your day now. There is no role-based logic. The same drug interaction flag that fires for a hospitalist also fires for a surgeon or for a nurse practitioner. In fact, it fires identically, regardless of who's actually equipped to act on it in that moment. There is no contextual awareness. After all, an alert does not know you've already addressed this exact flag yesterday. It doesn't know that you're mid-encounter. It doesn't know that this is the fourth time this week it's told you the same thing. More importantly, there is no differentiation in urgency. A critical potassium level and a routine refill reminder arrive wearing the same visual costume, same color, same pop-up, same font size, same interruption. The published data on what that produces is not subtle. A systematic review in the Journal of American Medical Informatics Association, pooling 23 studies, found override rates range from 46 to 96%, depending on the alert type. Non G and colleagues studying three years of alerts at a large academic outpatient center found physicians overrode 73% of medication-related alerts specifically. Those are not numbers about careless physicians. Those are numbers about a system that was never calibrated to clinical reality in the first place. You see, clinical reality was never part of the design brief. It was all about the certification. No one ever asked a physician. It was designed by engineers for corporations to meet a government metric. Physician was just thrown under the bus with the rest of the clinical healthcare team. When every alert looks and feels the same, your brain does exactly what brains are built to do with constant undifferentiated noise. It stops treating each one as new information. It starts treating the whole category's background. That's not a disimmon problem. That's a basic human neurology responding rationally to a badly designed environment. In a 2013 Sentinel Event Alert on alarm fatigue, they described exactly this dynamic: high alert volume desensitizing clinicians until true signals get missed inside the noise. The Agency for Healthcare Research and Quality still lists this issue as an active patient safety concern in their PS net primer. So the risk was never physicians ignoring alerts because they're lazy. The risk was always, hey, let's build a system that cries wolf enough, and eventually the wolf gets through the system. We didn't design that outcome. Nobody sat in a room and decided to bury the potassium level under three low-value pings. That's what we got. Because the system was engineered to satisfy an auditor, not to protect a physician's attention. Now, I know where some of you go next because I've been there too. Just turn it all off, mute the category, get it out of my day. I just don't want those alerts in the middle of my cases anymore. Well, unfortunately, that is the wrong fix, too. I want to be straight with you about why. See, underneath the noise, some of those alerts are catching real things, a genuine interaction, a genuine critical value. Blanket suppression doesn't solve calibration problems. It just trades one failure mode for a worse one. The actual fix was never fewer alerts or more alerts. It was always alerts calibrated to who you are, what you're doing right now, and how clinically significant is this specific flag, which is precisely the kind of judgment a compliance checkbox was never built to make. So what would it look like if physicians had been in the rope when this whole system got built instead of what it actually was, a certification deadline? Well, the system would know your role and would route things to you accordingly. A critical flag reaches the physician who can act on it now, not everyone with a login. It would know your context. It wouldn't repeat what you've already acknowledged, and it certainly wouldn't compete for attention mid-surgical procedure the same way it competes during Tuesday afternoon in the office. And it would score urgency based on clinical significance, not on whether firing the alert protects the vendor from a lawsuit. That is not a minor user interface tweak. That's a completely different design philosophy, one built around physician judgment instead of around audit defensibility. That's the philosophy behind HCO practice HQ, the organizational communication module inside clinician core. Intelligent role-aware routing. Urgency scoring is built around clinical significance, not compliance minimums. HIPAA compliant and built from the ground up with physicians not only in the room, but truly, truly hands-on as the platform was built. Imagine physicians as the designers of what they really need to help them practice medicine efficiently, effectively, and enjoyably rather than just an end user of someone else's checklist. Here's what I want to leave with you today. The exhaustion you feel every time your EHR pings is not a discipline problem and it is not a personality flaw. It's the direct traceable result of a system that was built to satisfy a 2011 certification requirement, not to protect your attention or your patients. That means it's fixable, not by willpower or resilience training or by you having a better attitude. It's fixable with better engineering. I became a physician and surgeon in order to take care of patients, not to referee a stream of undifferentiated notifications. I suspect that you did too. I think it's worth saying plainly. The tools that were supposed to serve your judgment were for a long time built around something else entirely. If you're ready to see what an alert system actually designed around a physician's judgment is supposed to look like, then you need to experience Clinician Corps' HCO practice HQ. We're in soft launch now ahead of our full September release. The wait list is open at cliniciancore.com slash wait list. Visit our website and sign up. I'm Dr. Kevin Hallow, co founder and chief medical officer of Clinician Core. Let us handle the noise so that you can enjoy practicing medicine. Thanks for listening.