Department of Hospital Medicine, Kaiser Permanente, Woodland Hills, CA, USA.
J Am Med Inform Assoc. 2018 May 1;25(5):564-567. doi: 10.1093/jamia/ocx096.
Many institutions have implemented clinical decision support systems (CDSSs). While CDSS research papers have focused on benefits of these systems, there is a smaller body of literature showing that CDSSs may also produce unintended adverse consequences (UACs). Detailed here are 2 cases of UACs resulting from a CDSS. Both of these cases were related to external systems that fed data into the CDSS. In the first case, lack of knowledge of data categorization in an external pharmacy system produced a UAC; in the second case, the change of a clinical laboratory instrument produced the UAC. CDSSs rely on data from many external systems. These systems are dynamic and may have changes in hardware, software, vendors, or processes. Such changes can affect the accuracy of CDSSs. These cases point to the need for the CDSS team to be familiar with these external systems. This team (manager and alert builders) should include members in specific clinical specialties with deep knowledge of these external systems.
许多机构已经实施了临床决策支持系统（CDSS）。虽然 CDSS 研究论文侧重于这些系统的好处，但也有较少的文献表明 CDSS 也可能产生意外的不良后果（UAC）。这里详细介绍了由 CDSS 引起的 2 个 UAC 案例。这两个案例都与将数据输入 CDSS 的外部系统有关。在第一个案例中，外部药房系统中数据分类知识的缺乏导致了 UAC；在第二个案例中，临床实验室仪器的更改导致了 UAC。CDSS 依赖于来自许多外部系统的数据。这些系统是动态的，可能在硬件、软件、供应商或流程方面发生变化。此类更改可能会影响 CDSS 的准确性。这些案例表明，CDSS 团队需要熟悉这些外部系统。该团队（经理和警报构建者）应包括具有这些外部系统深入知识的特定临床专业的成员。
