title: Some unintended consequences of clinical decision support systems.
abstract: Clinical decision support systems (CDS) coupled with computerized physician/provider order entry (CPOE) can improve the quality of patient care and the efficiency of hospital operations. However, they can also produce unintended consequences. Using qualitative methods, a multidisciplinary team gathered and analyzed data about the unintended consequences of CPOE, identifying nine types, and found that CDS-generated unintended consequences appeared among all types. Further analysis of 47 CDS examples uncovered three themes related to CDS content: elimination or shifting of human roles; difficulty in keeping content current; and inappropriate content. Three additional themes related to CDS presentation were found: rigidity of the system; alert fatigue; and potential for errors. Management of CDS must include careful selection and maintenance of content and prudent decision making about human computer interaction opportunities.
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Emily M
authors.initials: EM
authors.lastname: Campbell
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Guappone
authors.forename: Richard H
authors.initials: RH
authors.lastname: Dykstra
mesh_terms: D020000:Decision Support Systems, Clinical; D004347:Drug Interactions; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D050316:Medical Order Entry Systems; D017010:Reminder Systems