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CDS Systems: Common Malfunctions, Practical Solutions

May 2017
For the Record


[Excerpted commentary from Dr. Erin Jospe, former Chief Medical Officer, PatientKeeper, Inc.]

"Whether the focus is avoiding error through alerting mechanisms or presenting context-specific evidence-based guidelines when placing orders, the ultimate goal is to improve the quality of care our patients receive," says Erin Jospe, MD, chief medical officer at PatientKeeper.

The ramifications of a CDS-generated error vary but they can be as impactful as any of its potential benefits. "Malfunctions can result in everything from the mundane annoyance to true harm," Jospe says. "As such, incredible vigilance is necessary for the maintenance and ongoing evolution of CDS systems. Any and every occurrence has possible significant patient harm associated with it, and even the least noteworthy consequences will still erode clinician faith in the reliability of the CDS tools as a whole."

"Much of the benefit of CDS tools stems from eliminating human error," Jospe says. "But I think we underestimate the effort of human maintenance of the CDS tools we have. The rules engines we build need constant reexamination, and organizations must plan for the downstream effects of seemingly unrelated changes, such as a drug dictionary change or a system upgrade as alluded to in [Wright's study].

"Quality health care delivery depends on the entire care team working together," she continues. "We need to remember that our computer workflows are entwined and interdependent. Communication between all the parts is key."

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