Examining clinical decision support integrity: is clinician self-reported data entry accurate?
Examining clinical decision support integrity: is clinician self-reported data entry accurate?
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DOI：
10.1136/amiajnl-2013-001617
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发表时间：
2014-01-01
影响因子：
6.4
通讯作者：
Khorasani, Ramin
中科院分区：
文献类型：
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作者：
Gupta, Anurag;Raja, Ali S.;Khorasani, Ramin
本研究的目的是评估临床决策支持（CDS）中临床医生输入数据的准确性。我们在急诊科使用cd引导下的CT血管造影（CTA）检查肺栓塞（PE）作为一个案例，因为它需要临床医生输入d -二聚体结果，这些结果可以明确地与实际实验室值进行比较。在2011年1296例疑似PE的CTA患者中，1175例（90.7%）输入了准确的d -二聚体值。在55个订单中（4.2%），错误输入的数据使临床医生无法接收侵入性计算机警报，导致潜在的CTA过度使用。剩余的数据输入错误不会影响用户工作流程。在我们的队列中没有发现遗漏的pe。临床医生在CDS成像中输入的大部分数据都是准确的。一小部分可能是故意错误的，以避免侵入性的计算机警报。可能需要质量改进方法，包括学术详细说明和改进电子病历与CDS之间的集成，以尽量减少冗余数据输入，以优化通过CDS提供的证据的采用。
The aim of this study was to assess the accuracy of clinician-entered data in imaging clinical decision support (CDS). We used CDS-guided CT angiography (CTA) for pulmonary embolus (PE) in the emergency department as a case example because it required clinician entry of D-dimer results which could be unambiguously compared with actual laboratory values. Of 1296 patients with CTA orders for suspected PE during 2011, 1175 (90.7%) had accurate D-dimer values entered. In 55 orders (4.2%), incorrectly entered data shielded clinicians from intrusive computer alerts, resulting in potential CTA overuse. Remaining data entry errors did not affect user workflow. We found no missed PEs in our cohort. The majority of data entered by clinicians into imaging CDS are accurate. A small proportion may be intentionally erroneous to avoid intrusive computer alerts. Quality improvement methods, including academic detailing and improved integration between electronic medical record and CDS to minimize redundant data entry, may be necessary to optimize adoption of evidence presented through CDS.