Analysis of clinical decision support system malfunctions: a case series and survey
Analysis of clinical decision support system malfunctions: a case series and survey
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DOI：
10.1093/jamia/ocw005
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发表时间：
2016-11-01
影响因子：
6.4
通讯作者：
Bates, David W.
中科院分区：
文献类型：
--
作者：
Wright, Adam;Hickman, Thu-Trang T.;Bates, David W.
目的 说明临床决策支持系统 (CDSS) 故障的方式并识别此类故障的模式。材料和方法 我们识别并调查了布莱根妇女医院的几个 CDSS 故障，并将它们作为案例系列进行呈现。我们还对首席医疗信息官进行了初步调查，以评估此类故障的频率。 结果 我们在布莱根妇女医院发现了四个 CDSS 故障：(1) 当另一个系统中胺碘酮的内部标识符发生更改时，监测接受胺碘酮的患者甲状腺功能的警报停止工作； (2) 当规则被无意编辑时，儿童铅筛查警报停止工作； (3) 电子健康记录软件的软件升级导致大量虚假警报被触发； (4) 外部药物分类系统出现故障，导致发出警报，向已经服用阿司匹林等抗血小板药物的患者提出不当建议。我们发现，在接受我们调查的首席医疗信息官中，93% 的人至少经历过一次 CDSS 故障，三分之二的人至少每年都会经历一次故障。 讨论 CDSS 故障很普遍，而且往往持续很长时间。火灾警报失败特别难以察觉。一系列原因，包括代码和字段的更改、软件升级、无意中禁用或编辑规则以及外部系统故障，通常会导致 CDSS 故障，而当前预防和检测此类故障的方法是不够的。结论 CDSS 故障经常发生，并且常常未被发现。需要更好的方法来预防和检测这些故障。
Objective To illustrate ways in which clinical decision support systems (CDSSs) malfunction and identify patterns of such malfunctions.Materials and Methods We identified and investigated several CDSS malfunctions at Brigham and Women's Hospital and present them as a case series. We also conducted a preliminary survey of Chief Medical Information Officers to assess the frequency of such malfunctions.Results We identified four CDSS malfunctions at Brigham and Women's Hospital: (1) an alert for monitoring thyroid function in patients receiving amiodarone stopped working when an internal identifier for amiodarone was changed in another system; (2) an alert for lead screening for children stopped working when the rule was inadvertently edited; (3) a software upgrade of the electronic health record software caused numerous spurious alerts to fire; and (4) a malfunction in an external drug classification system caused an alert to inappropriately suggest antiplatelet drugs, such as aspirin, for patients already taking one. We found that 93% of the Chief Medical Information Officers who responded to our survey had experienced at least one CDSS malfunction, and two-thirds experienced malfunctions at least annually.Discussion CDSS malfunctions are widespread and often persist for long periods. The failure of alerts to fire is particularly difficult to detect. A range of causes, including changes in codes and fields, software upgrades, inadvertent disabling or editing of rules, and malfunctions of external systems commonly contribute to CDSS malfunctions, and current approaches for preventing and detecting such malfunctions are inadequate.Conclusion CDSS malfunctions occur commonly and often go undetected. Better methods are needed to prevent and detect these malfunctions.