EHR Alerts Fail to Cut Down Diabetes Drugs, Study Finds

A big health network tried to use computer prompts in doctors’ records to tell them when older patients on blood‑sugar medicine could stop taking it. The idea was that these “nudges” would help follow a national campaign called Choosing Wisely, which urges doctors to reduce unnecessary medication. The trial was run as a real‑world experiment. Doctors received a series of alerts whenever a patient’s medication plan didn’t match the latest guidelines for people over 65 with type 2 diabetes. Earlier, a smaller pilot had shown that the alerts increased guideline‑compliant stopping by about five percent.In the full study, however, doctors did not change their prescribing habits. The researchers looked closely at the comments that clinicians wrote in response to each alert. Many of them said the messages were too generic, came at bad times, or didn’t fit the patient’s specific situation. Some doctors felt they were being told what to do instead of helping them decide. The comments also revealed that the alerts often conflicted with other parts of the record system, making them hard to notice. Others noted that patients were sometimes resistant to stopping medication, and the alerts did not help address those concerns. The findings suggest that simply adding computer nudges is not enough. To make such tools useful, the alerts need to be more personalized, less intrusive, and integrated smoothly into daily workflow. Future efforts should also involve patients in the conversation about when to reduce medication.