ArticleJournal of the American Medical Informatics Association : JAMIA2016
Analysis of clinical decision support system malfunctions: a case series and survey.
Article in Journal of the American Medical Informatics Association : JAMIA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 5 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
62 citing papers in PubMed, 5 syntheses or guidelines pooled it, 128 citations in OpenAlex.
- Real-World Performance Measurement of Patient-Centered Clinical Decision Support Tools: Qualitative Study.JMIR formative research · 2026Pooled it
- Impact of Clinicians' Use of Electronic Knowledge Resources on Clinical and Learning Outcomes: Systematic Review and Meta-Analysis.Journal of medical Internet research · 2019Pooled it
- A Systematic Review of Wearable Sensors and IoT-Based Monitoring Applications for Older Adults - a Focus on Ageing Population and Independent Living.Journal of medical systems · 2019Pooled it
- A Systematic Review of Wearable Patient Monitoring Systems - Current Challenges and Opportunities for Clinical Adoption.Journal of medical systems · 2017Pooled it
- A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care.Journal of the American Medical Informatics Association : JAMIA · 2017Pooled it
- Promoting palliative care for people with heart failure: the P3HF study protocol.BMC palliative care · 2026Article
- Development and application of desiderata for automated clinical ordering.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Combining International Standards to Develop Clinical Decision Support for Parent Smoking Cessation in Pediatrics.Journal of medical Internet research · 2025Article
- Optimizing Order Sets With a Large Language Model-Powered Multiagent System.JAMA network open · 2025Article
- The feasibility of integrating an alcohol screening clinical decision support tool into primary care clinical software: a review and Australian key stakeholder study.BMC primary care · 2024Review
- A scoping review of rule-based clinical decision support malfunctions.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- In pursuit of the alert fatigue: an assessment of drug alert burden at a large academic medical center.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2024Article
- Clinical decision support malfunctions related to medication routes: a case series.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Real-Time User Feedback to Support Clinical Decision Support System Improvement.Applied clinical informatics · 2022Article
- Factors driving provider adoption of the TREWS machine learning-based early warning system and its effects on sepsis treatment timing.Nature medicine · 2022Article
- Acceptance, Barriers, and Facilitators to Implementing Artificial Intelligence-Based Decision Support Systems in Emergency Departments: Quantitative and Qualitative Evaluation.JMIR formative research · 2022Article
- Clinician collaboration to improve clinical decision support: the Clickbusters initiative.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Clinical Decision Support Stewardship: Best Practices and Techniques to Monitor and Improve Interruptive Alerts.Applied clinical informatics · 2022Review
- Alerts in Clinical Decision Support Systems (CDSS): A Bibliometric Review and Content Analysis.Healthcare (Basel, Switzerland) · 2022Article
- Leveraging law and ethics to promote safe and reliable AI/ML in healthcare.Frontiers in nuclear medicine · 2022Review
2 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
11 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo illustrate ways in which clinical decision support systems (CDSSs) malfunction and identify patterns of such malfunctions. MATERIALS AND
methodsWe 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.
resultsWe 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.
conclusionCDSS malfunctions occur commonly and often go undetected. Better methods are needed to prevent and detect these malfunctions.
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.