ArticleJournal of the American Medical Informatics Association : JAMIA2018
Smashing the strict hierarchy: three cases of clinical decision support malfunctions involving carvedilol.
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 7 papers.
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
7 citing papers in PubMed.
- Diagnosis classification in EMR data using latent representations and SNOMED-CT mapping for improved medical data integration.Medical & biological engineering & computing · 2026Article
- Development and application of desiderata for automated clinical ordering.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Clinical Decision Support for Patient Cases with Asymptomatic Carotid Artery Stenosis Using AI Models and Electronic Medical Records.Journal of cardiovascular development and disease · 2025Article
- Real-Time User Feedback to Support Clinical Decision Support System Improvement.Applied clinical informatics · 2022Article
- The use of cognitive task analysis in clinical and health services research - a systematic review.Pilot and feasibility studies · 2022Review
- A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system.International journal of clinical pharmacy · 2021Article
- Algorithmic Detection of Boolean Logic Errors in Clinical Decision Support Statements.Applied clinical informatics · 2021Article
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
Clinical vocabularies allow for standard representation of clinical concepts, and can also contain knowledge structures, such as hierarchy, that facilitate the creation of maintainable and accurate clinical decision support (CDS). A key architectural feature of clinical hierarchies is how they handle parent-child relationships - specifically whether hierarchies are strict hierarchies (allowing a single parent per concept) or polyhierarchies (allowing multiple parents per concept). These structures handle subsumption relationships (ie, ancestor and descendant relationships) differently. In this paper, we describe three real-world malfunctions of clinical decision support related to incorrect assumptions about subsumption checking for β-blocker, specifically carvedilol, a non-selective β-blocker that also has α-blocker activity. We recommend that 1) CDS implementers should learn about the limitations of terminologies, hierarchies, and classification, 2) CDS implementers should thoroughly test CDS, with a focus on special or unusual cases, 3) CDS implementers should monitor feedback from users, and 4) electronic health record (EHR) and clinical content developers should offer and support polyhierarchical clinical terminologies, especially for medications.
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.