Clinical Decision Support Systems Could Be Modified To Reduce 'Alert Fatigue' While Still Minimizing The Risk Of Litigation
Clinical Decision Support Systems Could Be Modified To Reduce 'Alert Fatigue' While Still Minimizing The Risk Of Litigation
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DOI：
10.1377/hlthaff.2010.1111
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发表时间：
2011-12-01
期刊：
影响因子：
9.7
通讯作者：
Sheikh, Aziz
中科院分区：
文献类型：
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作者：
Kesselheim, Aaron S.;Cresswell, Kathrin;Sheikh, Aziz
临床决策支持系统（帮助医生做出临床选择的交互式计算机系统）可以通过提供有关可能的不良反应的实时警报来减少药物处方中的错误。但医生和其他用户经常遭受“警觉疲劳”，这是由于对潜在危险的药物相互作用等项目的警告过多所致。因此，他们可能不太注意甚至忽略一些重要的警报，从而限制了这些系统的有效性。设计师和供应商严格限制修改警报系统的能力，因为他们担心如果允许删除本可以防止有害处方错误的警告，他们将承担责任。然而，我们对产品责任原则和现有临床决策支持系统使用研究的分析发现，更精细的定制或简约的警告可以缓解警报疲劳，而不会给供应商，购买者和用户带来高风险的诉讼。即便如此，为了限制这一领域的责任，我们建议政府加强对临床决策支持系统的监管，并制定国际实践指南，强调最重要的警告。
Clinical decision support systems-interactive computer systems that help doctors make clinical choices-can reduce errors in drug prescribing by offering real-time alerts about possible adverse reactions. But physicians and other users often suffer "alert fatigue" caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems' effectiveness. Designers and vendors sharply limit the ability to modify alert systems because they fear being exposed to liability if they permit removal of a warning that could have prevented a harmful prescribing error. Our analysis of product liability principles and existing research into the use of clinical decision support systems, however, finds that more finely tailored or parsimonious warnings could ease alert fatigue without imparting a high risk of litigation for vendors, purchasers, and users. Even so, to limit liability in this area, we recommend stronger government regulation of clinical decision support systems and development of international practice guidelines highlighting the most important warnings.