title: Better medicine by default.
abstract: BACKGROUND
  American health care is transitioning to electronic physician ordering. These computerized systems are unique because they allow custom order interfaces. Although these systems provide great benefits, there are also potential pitfalls, as the behavioral sciences have shown that the very format of electronic interfaces can influence decision making. The current research specifically examines how defaults in electronic order templates affect physicians' treatment decisions and medical errors.
  
  
  METHODS
  Forty-five medical residents completed order sets for 3 medical case studies. Participants were randomly assigned to receive order sets with either "opt-in" defaults (options visible but unselected) or "opt-out" defaults (options visible and preselected).
  
  
  RESULTS
  compare error rates between conditions and examine the type and severity of errors most often made with opt-in versus opt-out defaults. Results. Opt-out defaults resulted in a greater number of items ordered and specifically increased commission errors (overordering) compared with opt-in defaults. However, while opt-in defaults resulted in fewer orders, they also increased omission errors. When the severity of the errors is taken into account, the default effects seem limited to less severe errors.
  
  
  CONCLUSIONS
  The defaults used in electronic order sets influence medical treatment decisions when the consequences to a patient's health are low. This pattern suggests that physicians cognitively override incorrect default choices but only to a point, and it implies tradeoffs that maximize accuracy and minimize cognitive effort. Results indicate that defaults for low-impact items on electronic templates warrant careful attention because physicians are unlikely to override them.
authors.affiliation: Northwestern University, Kellogg School of Management, Evanston, IL (CA).
authors.forename: Cara
authors.initials: C
authors.lastname: Ansher
authors.forename: Dan
authors.initials: D
authors.lastname: Ariely
authors.forename: Alisa
authors.initials: A
authors.lastname: Nagler
authors.forename: Mariah
authors.initials: M
authors.lastname: Rudd
authors.forename: Janet
authors.initials: J
authors.lastname: Schwartz
authors.forename: Ankoor
authors.initials: A
authors.lastname: Shah
mesh_terms: D007396:Internship and Residency; D019300:Medical Errors / Q000517:prevention & control; D011787:Quality of Health Care; D014481:United States; D014584:User-Computer Interface
keywords: default; electronic medical records; medical decision making; medical education; medical errors