ArticleJournal of the American Medical Informatics Association : JAMIA
Overrides of medication-related clinical decision support alerts in outpatients.
Article in Journal of the American Medical Informatics Association : JAMIA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 117 papers, 10 of them syntheses that pooled it.
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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.
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Who cites it
117 citing papers in PubMed, 10 syntheses or guidelines pooled it.
- AI-Based Clinical Decision Support Systems in Primary Care: Systematic Review of Clinical Implementation.Journal of medical Internet research · 2026Pooled it
- Alert fatigue measurement in clinical decision support: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2026Pooled it
- A systematic review of the impact of health information technology on nurses' time.Journal of the American Medical Informatics Association : JAMIA · 2020Pooled it
- Using clinical reasoning ontologies to make smarter clinical decision support systems: a systematic review and data synthesis.Journal of the American Medical Informatics Association : JAMIA · 2020Pooled it
- Medication safety alert fatigue may be reduced via interaction design and clinical role tailoring: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2019Pooled it
- Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2018Pooled it
- Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review.Journal of medical Internet research · 2018Pooled it
- Behavioral Economics Interventions in Clinical Decision Support Systems.Yearbook of medical informatics · 2018Pooled 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
- Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review.Journal of hospital medicine · 2015Pooled it
- Implementing prescriber-pharmacist collaboration to improve evidence-based medication prescribing using asynchronous, non-interruptive electronic health record notifications.Implementation science : IS · 2025Trial
- Effect of an Electronic Health Record "Nudge" on Opioid Prescribing and Electronic Health Record Keystrokes in Ambulatory Care.Journal of general internal medicine · 2021Trial
- The effect of medication cost transparency alerts on prescriber behavior.Journal of the American Medical Informatics Association : JAMIA · 2019Trial
- Development of a hybrid artificial intelligence framework for pharmacotherapy optimization.International journal of clinical pharmacy · 2026Article
- Explaining the experiences of stakeholders in design evaluation criteria for the electronic prescribing system in Iran: a qualitative study.BMC health services research · 2026Article
- Integrating clinical decision support systems, nursing vigilance, and physician prescribing patterns to reduce preventable adverse drug events: a structured evidence-based narrative review on human-AI interface in medication safety.Frontiers in digital health · 2026Review
- A standard-based taxonomy of features that affect user response to clinical decision support alerts.BMC medical informatics and decision making · 2025Article
- Visual analysis of research hot topics and trends of clinical decision support system based on CiteSpace.Langenbeck's archives of surgery · 2025Review
- Antihypertensive drug-related problems in Vietnamese ambulatory care.Scientific reports · 2025Article
- Using shared clinical decision support to reduce adverse drug events and improve patient safety.Frontiers in digital health · 2025Review
57 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundElectronic prescribing is increasingly used, in part because of government incentives for its use. Many of its benefits come from clinical decision support (CDS), but often too many alerts are displayed, resulting in alert fatigue.
objectiveTo characterize the override rates for medication-related CDS alerts in the outpatient setting, the reasons cited for overrides at the time of prescribing, and the appropriateness of overrides.
methodsWe measured CDS alert override rates and the coded reasons for overrides cited by providers at the time of prescribing. Our primary outcome was the rate of CDS alert overrides; our secondary outcomes were the rate of overrides by alert type, reasons cited for overrides at the time of prescribing, and override appropriateness for a subset of 600 alert overrides. Through detailed chart reviews of alert override cases, and selective literature review, we developed appropriateness criteria for each alert type, which were modified iteratively as necessary until consensus was reached on all criteria.
resultsWe reviewed 157,483 CDS alerts (7.9% alert rate) on 2,004,069 medication orders during the study period. 82,889 (52.6%) of alerts were overridden. The most common alerts were duplicate drug (33.1%), patient allergy (16.8%), and drug-drug interactions (15.8%). The most likely alerts to be overridden were formulary substitutions (85.0%), age-based recommendations (79.0%), renal recommendations (78.0%), and patient allergies (77.4%). An average of 53% of overrides were classified as appropriate, and rates of appropriateness varied by alert type (p<0.0001) from 12% for renal recommendations to 92% for patient allergies. DISCUSSION: About half of CDS alerts were overridden by providers and about half of the overrides were classified as appropriate, but the likelihood of overriding an alert varied widely by alert type. Refinement of these alerts has the potential to improve the relevance of alerts and reduce alert fatigue.
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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.