Study: CDS problems widespread and underreported

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
 - errors

There are widespread problems tied to clinical decision support systems in U.S. hospitals, which could be having a negative effect on patient safety.

That’s the finding of a study published by the Journal of the American Medical Informatics Association.

The study, led by Adam Wright, PhD, senior scientist at Brigham and Women’s Hospital in Boston, identified and investigated several malfunctions in CDS systems at the hospital. It also included a preliminary survey of chief medical information officers to assess the frequency of such malfunctions.

Researchers found a whopping 93 percent of the 29 CMIOs surveyed had experienced at least one CDS system malfunction, while two-thirds experienced malfunctions at least annually. Among the most common contributing factors to malfunctions reported by the CMIOs, 18 reported malfunctions occurring at the time of an upgrade of EHR software, and 18 reported issues related to changes in data codes or data fields—both of which are known high-risk events for malfunctions.

The following four kinds of CDS system malfunctions were identified at Brigham and Women’s:

  • An alert for monitoring thyroid function in patients receiving amiodarone stopped working when an internal identifier for amiodarone was changed in another system.
  • An alert for lead screening for children stopped working when the rule was inadvertently edited.
  • A software upgrade of the EHR software caused numerous spurious alerts to fire.
  • A malfunction in an external drug classification system caused an alert to inappropriately suggest antiplatelet drugs, such as aspirin, for patients already taking one.

Unfortunately, the researchers believe that many CDS malfunctions go undetected so the true rate is much higher.

Wright et al. call for tools to monitor how well CDS is working as well as intervention when there is a problem.

“The failure of alerts to fire is particularly difficult to detect,” they wrote, citing a range of causes, from changes in codes and fields and software upgrades to inadvertent disabling or editing of rules and malfunctions of external systems commonly contribute to these malfunctions. “Current approaches for preventing and detecting CDSS malfunctions are inadequate. As CDSSs becomes more complex and widespread and clinicians increase their reliance on them, improved processes and tools for preventing and detecting CDSS malfunctions are essential.”