ArticleApplied clinical informatics2019
Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study.
Article in Applied clinical informatics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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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.
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Who cites it
8 citing papers in PubMed.
- Clinical Decision Support to Reduce Hospital Length-of-Stay for Cancer Patients with Fever and Neutropenia.Applied clinical informatics · 2025Article
- Sharing a Hybrid Electronic Health Record + Fast Healthcare Interoperability Resources Clinical Decision Support across Health Systems: Automating Smoking Cessation for Pediatric Caregivers.Applied clinical informatics · 2025Article
- A scoping review of rule-based clinical decision support malfunctions.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Human-centered development of an electronic health record-embedded, interactive information visualization in the emergency department using fast healthcare interoperability resources.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Translating an evidence-based clinical pathway into shareable CDS: developing a systematic process using publicly available tools.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- Clinical Decision Support and Implications for the Clinician Burnout Crisis.Yearbook of medical informatics · 2020Review
- Towards a Maturity Model for Clinical Decision Support Operations.Applied clinical informatics · 2019Article
- Improving the Effectiveness of Health Information Technology: The Case for Situational Analytics.Applied clinical informatics · 2019Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWith the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem.
objectiveThis article identifies technology failures that impacted clinical care related to web service-based advanced custom CDS systems embedded in the complex sociotechnical context of a production EHR.
methodsIn an academic health system's primary care network, we performed an inventory of incidents between January 1, 2008 and December 31, 2016 related to a customized CDS system and performed a targeted review of changes in the CDS source code. Additional feedback on the root cause of individual incidents was obtained through interviews with members of the CDS project teams.
resultsWe identified five CDS malfunctions that impaired clinical workflow. The mechanisms for these failures are mapped to four characteristics of well-behaved applications: (1) system integrity; (2) data integrity; (3) reliability; and (4) scalability. Over the 9-year period, two malfunctions of the customized CDS significantly impaired clinical workflow for a total of 5 hours. Lesser impacts-loss of individual features with straightforward workarounds-arose from three malfunctions, which affected users on 53 days. DISCUSSION: Advanced customization of EHRs for the purpose of CDS can present significant risks to clinical workflow.
conclusionThis case study highlights that advanced customization of CDS within a commercial EHR may support care for complex patient populations, but ongoing monitoring and support is required to ensure its safe use.
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Registered trials
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