SynthesisJournal of the American Medical Informatics Association : JAMIA2018
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Synthesis 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 67 papers, 4 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
67 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Nurses' Adherence to Double-Checking: A Systematic Review of Influencing Factors, Improvement Strategies, and Their Effectiveness.International nursing review · 2026Pooled it
- Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned.BMC public health · 2024Pooled it
- Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review.Paediatric drugs · 2024Pooled it
- Medication safety alert fatigue may be reduced via interaction design and clinical role tailoring: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2019Pooled it
- User Actions within a Clinical Decision Support Alert for the Management of Hypertension in Chronic Kidney Disease.Applied clinical informatics · 2025Trial
- Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.Journal of the American Medical Informatics Association : JAMIA · 2022Trial
- User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial.BMJ (Clinical research ed.) · 2022Trial
- Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department.The Journal of emergency medicine · 2022Trial
- Pediatric clinician perspectives on clinical decision support tools for chronic kidney disease risk after preterm birth.Pediatric nephrology (Berlin, Germany) · 2026Article
- Improving End-of-Life Screening in the Emergency Department With Collaborative Artificial Intelligence.Annals of emergency medicine · 2026Article
- Qualitative Study of Inpatient Hospital Medicine Interruptive Alerts and Clinical Decision Support.Applied clinical informatics · 2026Article
- User-Directed vs Interruptive Real-Time Benefit Tools for Medication Changes in Primary Care.JAMA network open · 2026Article
- Exploring the Impact of Electronic Medical Record-Enabled Versus Paper-Based Systems on the Quality of Nursing Handover: Comparative Case-Study.JMIR nursing · 2026Article
- Heavy Metal Toxicity in Clinical and Environmental Health: Sources, Mechanisms, Diagnostics, and Evidence-Based Management of Mercury, Lead, Cadmium, and Arsenic.International journal of molecular sciences · 2026Review
- Indication-based clinical decision support for inpatient urine testing: impacts on utilization, appropriateness, and antibiotic prescribing.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Digitally Enabled Discharge Quality After Neurosurgical Traumatic Brain Injury: A 10-Year Cohort from a Brazilian Public Tertiary Center.Healthcare (Basel, Switzerland) · 2025Article
- The challenges of using electronic medical records (EMR) to facilitate guideline-directed medical therapy (GDMT) for patients with heart failure (HF) and chronic kidney disease (CKD).Heart failure reviews · 2025Review
- A Measurement Science Framework to Optimize CDS for Opioid Use Disorder Treatment in the ED.Applied clinical informatics · 2025Article
- NOTICE-ED: Nurse or Technician Insights Into Cognitive Evaluations in the Emergency Department.Journal of the American Geriatrics Society · 2025Article
- Sisyphus' Alert: The Uphill Struggle to Improve Venous Thromboembolism Prophylaxis Clinical Decision Support.Applied clinical informatics · 2025Article
7 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
5 authors.
Funding
Abstract
Objective: Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, we asked 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts? Methods and Materials: Studies evaluating computerized hard-stop alerts in healthcare settings were identified from biomedical and computer science databases, gray literature sites, reference lists, and reviews. Articles were extracted for process outcomes, health outcomes, unintended consequences, user experience, and technical details. Results: Of 32 studies, 15 evaluated health outcomes, 16 process outcomes only, 10 user experience, and 4 compared hard and soft stops. Seventy-nine percent showed improvement in health outcomes and 88% in process outcomes. Studies reporting good user experience cited heavy user involvement and iterative design. Eleven studies reported on unintended consequences including avoidance of hard-stopped workflow, increased alert frequency, and delay to care. Hard stops were superior to soft stops in 3 of 4 studies. Conclusions: Hard stops can be effective and powerful tools in the CDS armamentarium, but they must be implemented judiciously with continuous user feedback informing rapid, iterative design. Investigators must report on associated health outcomes and unintended consequences when implementing IT solutions to clinical problems.
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.