ArticleJournal of the American Medical Informatics Association : JAMIA2018
Clinical decision support alert malfunctions: analysis and empirically derived taxonomy.
Article in Journal of the American Medical Informatics Association : JAMIA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 2 of them syntheses that pooled it.
What it found
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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
48 citing papers in PubMed, 2 syntheses or guidelines pooled 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
- 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
- An explainable ensemble for diabetic retinopathy grading with a novel confidence quality factor and configurable heatmaps.Medical & biological engineering & computing · 2026Article
- Equity at the point of care: auditing AI-supported resource allocation in obstetric emergencies.Frontiers in public health · 2026Article
- Development and application of desiderata for automated clinical ordering.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Optimizing Loop Diuretic Treatment for Mortality Reduction in Patients With Acute Dyspnea Using a Practical Offline Reinforcement Learning Pipeline for Health Care: Retrospective Single-Center Simulation Study.JMIR medical informatics · 2025Article
- From Trust in Automation to Trust in AI in Healthcare: A 30-Year Longitudinal Review and an Interdisciplinary Framework.Bioengineering (Basel, Switzerland) · 2025Review
- A Systematic Approach to Screen, Identify, and Correct Malfunctioning Interruptive Alerts.Applied clinical informatics · 2025Article
- Improving Discrete Documentation of Cancer Staging-An Alert-Free Approach.Applied clinical informatics · 2025Article
- A Case Study: Optimizing CDS for Pediatric Oncology Trials by Transitioning from Interruptive to Passive Alerts.Applied clinical informatics · 2025Article
- New Performance Measurement Framework for Realizing Patient-Centered Clinical Decision Support: Qualitative Development Study.Journal of medical Internet research · 2025Article
- A scoping review of rule-based clinical decision support malfunctions.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- A lightweight xAI approach to cervical cancer classification.Medical & biological engineering & computing · 2024Article
- Why do users override alerts? Utilizing large language model to summarize comments and optimize clinical decision support.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- [Factors influencing the implementation of AI-based decision support systems for antibiotic prescription in hospitals: a qualitative analysis from the perspective of health professionals].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2023Article
- A Robust Ensemble of Convolutional Neural Networks for the Detection of Monkeypox Disease from Skin Images.Sensors (Basel, Switzerland) · 2023Article
- Article
- Analysis of Publication Activity and Research Trends in the Field of AI Medical Applications: Network Approach.International journal of environmental research and public health · 2023Article
- Clinical decision support malfunctions related to medication routes: a case series.Journal of the American Medical Informatics Association : JAMIA · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
Objective: To develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions. Materials and Methods: We identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions. Results: We analyzed 68 CDS alert malfunction cases from 14 sites across the United States with diverse electronic health record systems. Four primary axes emerged: the cause of the malfunction, its mode of discovery, when it began, and how it affected rule firing. Build errors, conceptualization errors, and the introduction of new concepts or terms were the most frequent causes. User reports were the predominant mode of discovery. Many malfunctions within our database caused rules to fire for patients for whom they should not have (false positives), but the reverse (false negatives) was also common. Discussion: Across organizations and electronic health record systems, similar malfunction patterns recurred. Challenges included updates to code sets and values, software issues at the time of system upgrades, difficulties with migration of CDS content between computing environments, and the challenge of correctly conceptualizing and building CDS. Conclusion: CDS alert malfunctions are frequent. The empirically derived taxonomy formalizes the common recurring issues that cause these malfunctions, helping CDS developers anticipate and prevent CDS malfunctions before they occur or detect and resolve them expediently.
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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.