A Scoping Review of Rule-Based Clinical Decision Support Malfunctions

Authors

Jeritt G Thayer
Amy Franklin
Jeffrey M Miller
Robert W Grundmeier
Deevakar Rogith
Adam Wright

Language

English

Publication Date

10-1-2024

Journal

Journal of the American Medical Informatics Association

DOI

10.1093/jamia/ocae187

PMID

39078287

PMCID

PMC11413449

PubMedCentral® Posted Date

7-30-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: Conduct a scoping review of research studies that describe rule-based clinical decision support (CDS) malfunctions.

Materials and methods: In April 2022, we searched three bibliographic databases (MEDLINE, CINAHL, and Embase) for literature referencing CDS malfunctions. We coded the identified malfunctions according to an existing CDS malfunction taxonomy and added new categories for factors not already captured. We also extracted and summarized information related to the CDS system, such as architecture, data source, and data format.

Results: Twenty-eight articles met inclusion criteria, capturing 130 malfunctions. Architectures used included stand-alone systems (eg, web-based calculator), integrated systems (eg, best practices alerts), and service-oriented architectures (eg, distributed systems like SMART or CDS Hooks). No standards-based CDS malfunctions were identified. The "Cause" category of the original taxonomy includes three new types (organizational policy, hardware error, and data source) and two existing causes were expanded to include additional layers. Only 29 malfunctions (22%) described the potential impact of the malfunction on patient care.

Discussion: While a substantial amount of research on CDS exists, our review indicates there is a limited focus on CDS malfunctions, with even less attention on malfunctions associated with modern delivery architectures such as SMART and CDS Hooks.

Conclusion: CDS malfunctions can and do occur across several different care delivery architectures. To account for advances in health information technology, existing taxonomies of CDS malfunctions must be continually updated. This will be especially important for service-oriented architectures, which connect several disparate systems, and are increasing in use.

Keywords

Decision Support Systems, Clinical, Humans, Clinical Decision Rules, decision support systems, clinical, equipment failure analysis, health information technology, health information interoperability/standards, software

Published Open-Access

yes

Recommended Citation

Thayer, Jeritt G; Franklin, Amy; Miller, Jeffrey M; et al., "A Scoping Review of Rule-Based Clinical Decision Support Malfunctions" (2024). Faculty, Staff and Student Publications. 706.
https://digitalcommons.library.tmc.edu/uthshis_docs/706