Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 3)

Unintended Consequences of Clinical Decision Support Systems

Source:SailingScuttle

Now, I will go a step further to discuss the unintended consequences of CDSS. These can be seen as side effects or unforeseen consequences of the implementation of these systems. A lot of the information in this article will be taken from the article by Joan Ash and colleagues at the School of Medicine, Oregon Health and Science University in Portland Oregon. For the complete paper, click here.

The authors of this paper highlighted a few unintended consequences of clinical decision support systems which they found during their qualitative research in the form of observation and formal interviews. They noted that these unintended consequences were derived from either the content of the information or the way the information was presented to the health professional in question.

Source: Creative Nursing Education

Major consequences related to content included the fact that the database had to be updated pretty frequently due to new evidence and expanding knowledge in various fields. Sometimes this is not done quickly enough and can give rise to problems later on. Another related problem is that the content might just be plain incorrect due to errors in the algorithmic process or inaccurate information leading to a general mistrust and lack of use of the system in general.

Possible consequences related to the way the information is processed include the major problem of alert-fatigue,when the sheer number of alerts causes you to ignore most of the alerts which are considered superfluous but also mean some important alerts are likely to be ignored.

Other consequences can include input errors like typographical errors and mis-insertion of data like choosing the wrong option on a list as well as rigid systems which might not be configured to meet the exigencies of medical practice which is invariably more flexible.

These unintended consequences need to be factored in when designing clinical decision support systems and steps taken to remedy these problems when they arise.

Do not forget to comment on the discussion section in the previous post. Stay tuned for part 4