ArticleApplied clinical informatics2017
Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System.
Article in Applied clinical informatics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 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
15 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Use of Electronic Health Records to Study Drug-Induced Hypersensitivity Reactions from 2000 to 2021: A Systematic Review.Immunology and allergy clinics of North America · 2022Pooled it
- Evaluation of Potential Drug-Drug Interactions in Adults in the Intensive Care Unit: A Systematic Review and Meta-Analysis.Drug safety · 2019Pooled it
- Digital Health Technologies and Standardized Protocols for Patient Safety in Hospital-Based Settings: A Scoping Review.Journal of multidisciplinary healthcare · 2026Review
- A systematic review of clinicians' acceptance and use of clinical decision support systems over time.NPJ digital medicine · 2025Article
- User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation.JMIR formative research · 2024Article
- Applying requisite imagination to safeguard electronic health record transitions.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Overall performance of a drug-drug interaction clinical decision support system: quantitative evaluation and end-user survey.BMC medical informatics and decision making · 2022Article
- Clinical Decision Support System with Renal Dose Adjustment Did Not Improve Subsequent Renal and Hepatic Function among Inpatients: The Japan Adverse Drug Event Study.Applied clinical informatics · 2020Article
- Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems.Applied clinical informatics · 2020Article
- Current challenges in health information technology-related patient safety.Health informatics journal · 2020Article
- Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study.Applied clinical informatics · 2020Article
- Differences, Opportunities, and Strategies in Drug Alert Optimization-Experiences of Two Different Integrated Health Care Systems.Applied clinical informatics · 2019Article
- Structured override reasons for drug-drug interaction alerts in electronic health records.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Development and Evaluation of a Clinical Decision Support System to Improve Medication Safety.Applied clinical informatics · 2019Article
- Understanding Health Information Technology Induced Medication Safety Events by Two Conceptual Frameworks.Applied clinical informatics · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundElectronic health records (EHRs) with clinical decision support (CDS) have shown to be effective at improving patient safety. Despite this, alerts delivered as part of CDS are overridden frequently, which is of concern in the critical care population as this group may have an increased risk of harm. Our organization recently transitioned from an internally-developed EHR to a commercial system. Data comparing various EHR systems, especially after transitions between EHRs, are needed to identify areas for improvement.
objectivesTo compare the two systems and identify areas for potential improvement with the new commercial system at a single institution.
methodsOverridden medication-related CDS alerts were included from October to December of the systems' respective years (legacy, 2011; commercial, 2015), restricted to three intensive care units. The two systems were compared with regards to CDS presentation and override rates for four types of CDS: drug-allergy, drug-drug interaction (DDI), geriatric and renal alerts. A post hoc analysis to evaluate for adverse drug events (ADEs) potentially resulting from overridden alerts was performed for 'contraindicated' DDIs via chart review.
resultsThere was a significant increase in provider exposure to alerts and alert overrides in the commercial system (commercial: n=5,535; legacy: n=1,030). Rates of overrides were higher for the allergy and DDI alerts (p<0.001) in the commercial system. Geriatric and renal alerts were significantly different in incidence and presentation between the two systems. No ADEs were identified in an analysis of 43 overridden contraindicated DDI alerts.
conclusionsThe vendor system had much higher rates of both alerts and overrides, although we did not find evidence of harm in a review of DDIs which were overridden. We propose recommendations for improving our current system which may be helpful to other similar institutions; improving both alert presentation and the underlying knowledge base appear important.
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.