ReviewOchsner journal2014
Clinical decision support alert appropriateness: a review and proposal for improvement.
Review in Ochsner journal, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 6 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
85 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Design, effectiveness, and economic outcomes of contemporary chronic disease clinical decision support systems: a systematic review and meta-analysis.Journal of the American Medical Informatics Association : JAMIA · 2022Pooled it
- Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals.Journal of the American Medical Informatics Association : JAMIA · 2021Pooled 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
- 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
- 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
- Risk Model-Guided Clinical Decision Support for Suicide Screening: A Randomized Clinical Trial.JAMA network open · 2025Trial
- HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial.BMC primary care · 2022Trial
- Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.BMJ quality & safety · 2019Trial
- Using telehealth to support end of life care in the community: a feasibility study.BMC palliative care · 2016Trial
- Improving sepsis best practice utility and clinical acceptance using an LLM-enhanced prediction system.npj health systems · 2026Article
- Implementation of a Best Practice Advisory-Based HIV Screening Program in the Emergency Department with Integrated Infectious Diseases: A Descriptive Study.Open forum infectious diseases · 2026Article
- The 'Hippocratic Oath' for AI-based clinical decision support systems.BMC medical informatics and decision making · 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
- Partnerships to advance patient safety and address preventable harm: case studies from international health care leaders.Health affairs scholar · 2026Article
- From cognitive overload to institutional escalation: formalizing the supply-demand production condition in patient-safety failure.Frontiers in health services · 2026Article
- Analyzing the impact of pharmacogenomics-guided nonsteroidal anti-inflammatory drug alerts in clinical practice.JAMIA open · 2025Article
- Quantifying Healthcare Provider Perceptions of a Novel Deep Learning Algorithm to Predict Sepsis: Electronic Survey.Critical care explorations · 2025Article
- Care Team Attributes Predict Likelihood of Utilizing Pharmacogenomic Information During Inpatient Prescribing.Clinical and translational science · 2025Observational
- Development of a Human Factors-Based Guideline to Support the Design, Evaluation, and Continuous Improvement of Clinical Decision Support.Mayo Clinic proceedings. Digital health · 2025Article
25 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundMany healthcare providers are adopting clinical decision support (CDS) systems to improve patient safety and meet meaningful use requirements. Computerized alerts that prompt clinicians about drug-allergy, drug-drug, and drug-disease warnings or provide dosing guidance are most commonly implemented. Alert overrides, which occur when clinicians do not follow the guidance presented by the alert, can hinder improved patient outcomes.
methodsWe present a review of CDS alerts and describe a proposal to develop novel methods for evaluating and improving CDS alerts that builds upon traditional informatics approaches. Our proposal incorporates previously described models for predicting alert overrides that utilize retrospective chart review to determine which alerts are clinically relevant and which overrides are justifiable.
resultsDespite increasing implementations of CDS alerts, detailed evaluations rarely occur because of the extensive labor involved in manual chart reviews to determine alert and response appropriateness. Further, most studies have solely evaluated alert overrides that are appropriate or justifiable. Our proposal expands the use of web-based monitoring tools with an interactive dashboard for evaluating CDS alert and response appropriateness that incorporates the predictive models. The dashboard provides 2 views, an alert detail view and a patient detail view, to provide a full history of alerts and help put the patient's events in context.
conclusionThe proposed research introduces several innovations to address the challenges and gaps in alert evaluations. This research can transform alert evaluation processes across healthcare settings, leading to improved CDS, reduced alert fatigue, and increased patient safety.
Indexed as
Identifiers
24940129PMC4052586What 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.