Alert Fatigue: An Assault On Two Fronts


Today, nearly all hospital technology has at least some ability to generate, collect and transmit data. From the monitored chair that reduces a patient’s fall risk to the magnetic resonance scanner that can broadcast images and technical data anywhere in the world, these devices aren’t standalone. They are part of a larger hospital network of devices and equipment connected to one another, and to the Internet, leaving them vulnerable to intrusion.

These interconnected devices also generate huge amounts of data, making health care a driving force behind the explosion in big data. Technological developments such as the Industrial Internet and the Internet of Things – and in particular the collection and analysis of event-stream data from behavioral and biomedical telemetry – have left hospitals’ abilities to process and understand their data lagging behind their abilities to collect and store it. This gap not only exacerbates existing challenges around improving patient outcomes, maintaining safety and managing costs, but also creates new ones.

Let’s focus on a consequence with the potential to compromise the safety and efficacy of care on two fronts: alert fatigue. Alert fatigue happens when warnings or alarms are excessive to the point that one becomes desensitized to them – and it’s a growing problem with ramifications not only for frontline care provision but also for behind-the-scenes IT security.

Each day, a physician may encounter dozens of alarms from critical clinical systems and equipment used in the treatment of patients. The IT professional tasked with securing the network and devices that generate those alarms likely receives hundreds of alerts on a given day, each of them signaling a possible threat. What happens when an important warning is missed or ignored?

Alert fatigue on either front represents a known risk. Together, these challenges represent a clear and present danger to patients and caregivers – and to the hospitals charged to protect them.

Alert fatigue for clinicians

In 2013, the Joint Commission published a “Sentinel Event Alert” that identified alert fatigue as a significant and imminent patient safety problem. The American Association of Critical-Care Nurses that same year published Alarm Fatigue: A Patient Safety Concern, a study finding that between 72 percent and 99 percent of clinical alarms are false, leading to a general lack of confidence in them. These organizations and more around the globe have proven, with compelling empirical evidence, that alert fatigue is directly responsible for an ever-increasing number of patient injuries and deaths each year.

And as the Industrial Internet and the Internet of Things become omnipresent and help make e-health an everyday reality, alert fatigue will only become more prevalent. That’s a startling realization given aggressive growth in telehealth – the use of electronic data and telecommunication technologies to facilitate remote clinical care, education and public health initiatives.

Bidirectional data flow between patient and clinician is imperative to care delivery via health information technologies, making confidence in alarms and cybersecurity all the more critical in “remote” diagnosis and therapy via telemetry. With alert fatigue already a serious issue in traditional clinical settings – in hospitals managing large, diverse data streams within controlled environments – the time to act is now.

Alert fatigue in IT

When we consider what’s at stake for health care IT, we see a variety of data at risk: coveted patient information, drug development plans and road maps, clinical trial results and much more. The consequences of a breach range from financial loss (lawsuits, downtime, loss of proprietary information, etc.), brand and reputational damage, reduced patient safety, compromised drug integrity and compliance issues, among others.

As the number of networked devices expands, so too does a network’s attack surface. Each connection represents a potential portal for cybercriminals to gain access to sensitive data, and we live in an age when it’s no longer a matter of if an attacker can penetrate the network but when such an event will happen.

As in other industries, health care’s traditional approach to cybersecurity has been to buy ever more security products. The result: a mushrooming number of alarms (hundreds or thousands each day) for their IT teams to investigate – far more than even the best among them can effectively verify. Without an authoritative and efficient means to narrow, better qualify and prioritize those alarms, the events that signal the greatest threats are all too often lost in the noise.

Intelligent alerting through analytics

Health care needs an intelligent alert system to monitor and process event stream data from devices collecting and transmitting biomedical telemetry. As hospitals and technology companies develop the infrastructure to facilitate such, they should consider embedded, real-time, learning and adaptive data monitoring technologies that both support intelligent clinical alerting and provide visibility into abnormal network behavior.

Given data volumes – often billions of unique network events per day and growing – advanced analytics provide a scalable approach. Using in-line predictive analytics could ensure data stream integrity (regardless of size) and support decision making – whether to sound the alarm due to an impending clinical event or a potential cyberthreat.

Development of advanced alerting and cybermonitoring systems as described above will involve many vested parties, from device manufacturers to academic investigators to software developers, among others. As the industry and its partners learn of rising threats to hospital systems and the data they generate, there is a corresponding need to better understand the risk that such threats represent to patient and caregiver safety. Ultimately, we cannot remedy the human side of the alert fatigue epidemic without also addressing network integrity and security.