ArticleJournal of the American Medical Informatics Association : JAMIA2013
'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing.
Article in Journal of the American Medical Informatics Association : JAMIA, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.Journal of the American Medical Informatics Association : JAMIA · 2018Pooled it
- Computer decision support systems for asthma: a systematic review.NPJ primary care respiratory medicine · 2014Pooled it
- How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study.Journal of the American Medical Informatics Association : JAMIA · 2020Trial
- Effectiveness of a Hospital-Based Computerized Decision Support System on Clinician Recommendations and Patient Outcomes: A Randomized Clinical Trial.JAMA network open · 2019Trial
- The effect of medication cost transparency alerts on prescriber behavior.Journal of the American Medical Informatics Association : JAMIA · 2019Trial
- Fixing the Leaky Pipe: How to Improve the Uptake of Patient-Reported Outcomes-Based Prognostic and Predictive Models in Cancer Clinical Practice.JCO clinical cancer informatics · 2023Article
- Article
- Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review.BMC primary care · 2023Article
- Comparing Potential Drug-Drug Interactions in Companion Animal Medications Using Two Electronic Databases.Veterinary sciences · 2021Article
- Article
- Impact of Electronic Health Record Interface Design on Unsafe Prescribing of Ciclosporin, Tacrolimus, and Diltiazem: Cohort Study in English National Health Service Primary Care.Journal of medical Internet research · 2020Article
- Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis.PLoS medicine · 2020Article
- Understanding the utilisation of a novel interactive electronic medication safety dashboard in general practice: a mixed methods study.BMC medical informatics and decision making · 2020Article
- Impacts of Operational Failures on Primary Care Physicians' Work: A Critical Interpretive Synthesis of the Literature.Annals of family medicine · 2020Review
- Article
- Article
- Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation.BMC health services research · 2017Article
- Improving specialist drug prescribing in primary care using task and error analysis: an observational study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Observational
- Development of a computerised decisions support system for renal risk drugs targeting primary healthcare.BMJ open · 2015Article
- Technology, cognition and error.BMJ quality & safety · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
Abstract
objectiveComputerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care. MATERIALS AND
methodsQuantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices.
results132 prescriptions were issued in the course of 73 of the consultations, of which 81 (61%) attracted at least one alert. Of the total of 117 alerts, only three resulted in the GP checking, but not altering, the prescription. CDSS provided information and safety alerts at the point of generating a prescription. This was 'too much, too late' as the majority of the 'work' of prescribing occurred prior to using the computer. By the time an alert appeared, the GP had formulated the problem(s), potentially spent several minutes considering, explaining, negotiating, and reaching agreement with the patient about the proposed treatment, and had possibly given instructions and printed an information leaflet. DISCUSSION: CDSS alerts do not coincide with the prescribing workflow throughout the whole GP consultation. Current systems interrupt to correct decisions that have already been taken, rather than assisting formulation of the management plan.
conclusionsCDSS are likely to be more acceptable and effective if the prescribing support is provided much earlier in the process of generating a prescription.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.