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Analysis of clinical decision support system malfunctions: a case series and survey
- Source :
- Journal of the American Medical Informatics Association : JAMIA
- Publication Year :
- 2016
- Publisher :
- Oxford University Press (OUP), 2016.
-
Abstract
- Objective To illustrate ways in which clinical decision support systems (CDSSs) malfunction and identify patterns of such malfunctions.Materials and Methods We identified and investigated several CDSS malfunctions at Brigham and Women’s Hospital and present them as a case series. We also conducted a preliminary survey of Chief Medical Information Officers to assess the frequency of such malfunctions.Results We identified four CDSS malfunctions at Brigham and Women’s Hospital: (1) an alert for monitoring thyroid function in patients receiving amiodarone stopped working when an internal identifier for amiodarone was changed in another system; (2) an alert for lead screening for children stopped working when the rule was inadvertently edited; (3) a software upgrade of the electronic health record software caused numerous spurious alerts to fire; and (4) a malfunction in an external drug classification system caused an alert to inappropriately suggest antiplatelet drugs, such as aspirin, for patients already taking one. We found that 93% of the Chief Medical Information Officers who responded to our survey had experienced at least one CDSS malfunction, and two-thirds experienced malfunctions at least annually.Discussion CDSS malfunctions are widespread and often persist for long periods. The failure of alerts to fire is particularly difficult to detect. A range of causes, including changes in codes and fields, software upgrades, inadvertent disabling or editing of rules, and malfunctions of external systems commonly contribute to CDSS malfunctions, and current approaches for preventing and detecting such malfunctions are inadequate.Conclusion CDSS malfunctions occur commonly and often go undetected. Better methods are needed to prevent and detect these malfunctions.
- Subjects :
- clinical decision support
safety
020205 medical informatics
Drug classification
Amiodarone
Health Informatics
Medical information
02 engineering and technology
Research and Applications
Computer security
computer.software_genre
Hospitals, Special
Internal identifier
Clinical decision support system
Medical Order Entry Systems
03 medical and health sciences
0302 clinical medicine
Electronic health record
0202 electrical engineering, electronic engineering, information engineering
medicine
Humans
In patient
030212 general & internal medicine
Monitoring, Physiologic
Medical Errors
business.industry
Software upgrade
Decision Support Systems, Clinical
medicine.disease
anomaly detection
3. Good health
Lead Poisoning
electronic health records
machine learning
Child, Preschool
Organizational Case Studies
Equipment Failure
Medical emergency
Thyroid function
business
computer
Software
Boston
Subjects
Details
- ISSN :
- 1527974X and 10675027
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Journal of the American Medical Informatics Association
- Accession number :
- edsair.doi.dedup.....c10afd6536e04cd42be1f60e7123efa3