Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review

Poly, Tahmina Nasrin; Islam, Md.Mohaimenul; Yang, Hsuan-Chia; Li, Yu-Chuan (Jack)

doi:10.2196/15653

Cited by 118Electronic Health Records SystemsPatient Safety and Medication ErrorsPharmaceutical Practices and Patient Outcomes

Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review

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Poly, Tahmina Nasrin, Islam, Md.Mohaimenul, Yang, Hsuan-Chia, Li, Yu-Chuan (Jack)·2020·JMIR Medical Informatics

DOI 10.2196/15653PMC PMC7400042

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Abstract

BACKGROUND: The clinical decision support system (CDSS) has become an indispensable tool for reducing medication errors and adverse drug events. However, numerous studies have reported that CDSS alerts are often overridden. The increase in override rates has raised questions about the appropriateness of CDSS application along with concerns about patient safety and quality of care. OBJECTIVE: The aim of this study was to conduct a systematic review to examine the override rate, the reasons for the alert override at the time of prescribing, and evaluate the appropriateness of overrides. METHODS: We searched electronic databases, including Google Scholar, PubMed, Embase, Scopus, and Web of Science, without language restrictions between January 1, 2000 and March 31, 2019. Two authors independently extracted data and crosschecked the extraction to avoid errors. The quality of the included studies was examined following Cochrane guidelines. RESULTS: We included 23 articles in our systematic review. The range of average override alerts was 46.2%-96.2%. An average of 29.4%-100% of the overrides alerts were classified as appropriate, and the rate of appropriateness varied according to the alert type (drug-allergy interaction 63.4%-100%, drug-drug interaction 0%-95%, dose 43.9%-88.8%, geriatric 14.3%-57%, renal 27%-87.5%). The interrater reliability for the assessment of override alerts appropriateness was excellent (kappa=0.79-0.97). The most common reasons given for the override were "will monitor" and "patients have tolerated before." CONCLUSIONS: The findings of our study show that alert override rates are high, and certain categories of overrides such as drug-drug interaction, renal, and geriatric were classified as inappropriate. Nevertheless, large proportions of drug duplication, drug-allergy, and formulary alerts were appropriate, suggesting that these groups of alerts can be primary targets to revise and update the system for reducing alert fatigue. Future efforts should also focus on optimizing alert types, providing clear information, and explaining the rationale of the alert so that essential alerts are not inappropriately overridden.

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High override rates of 56.3%-95.7% have already been described for DDI alerts.
“High override rates of 56.3%-95.7% have already been described for DDI alerts [13, 21, 27–32].”
From Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey (2022) · cites this paper as [32]
The Results section, under “Override Rate and Appropriateness of Overrides,” reports DDI alert override rates of 56.3%–95.6%. This supports the claim that rates were high and its lower bound, but not the stated upper bound of 95.7%. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Our study results are in agreement with previous reports.
“Our study results are in agreement with previous reports.”
From Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey (2022) · cites this paper as [32]
The Results section reports findings from 23 prior studies on alert overrides, but the citing sentence does not say which results are being compared. Our copy cannot establish whether the citing authors’ unspecified results agree with those reports (searched for agreement with previous reports and consistent results). (LLM, conf=0.68)
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Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA Group* (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-4-200908180-00135 · Cited by 37,554 · see citing works
The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Meta-analysis of Observational Studies in Epidemiology<SUBTITLE>A Proposal for Reporting</SUBTITLE>
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Negotiating the coresearcher mandate – service users’ experiences of doing collaborative research on mental health
Moltu, C., Stefansen, J., Svisdahl, M., & Veseth, M. (2012) · Disability and Rehabilitation · doi:10.3109/09638288.2012.656792 · Cited by 1,247 · see citing works
Overriding of Drug Safety Alerts in Computerized Physician Order Entry
van der Sijs, H., Aarts, J., Vulto, A., & Berg, M. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1809 · Cited by 1,117 · see citing works
Increase in anaphylaxis-related hospitalizations but no increase in fatalities: An analysis of United Kingdom national anaphylaxis data, 1992-2012
Turner, P., Gowland, M. H., Sharma, V., Ierodiakonou, D., Harper, N. J. N., Garcez, T. P., Pumphrey, R. S. H., & Boyle, R. J. (2014) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2014.10.021 · Cited by 690 · see citing works
Physicians' Decisions to Override Computerized Drug Alerts in Primary Care
Weingart, S. N., Toth, M., Sands, D. Z., Aronson, M. D., Davis, R. B., & Phillips, R. S. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.21.2625 · Cited by 487 · see citing works
Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care
Shah, N. R., Seger, A. C., Seger, D. L., Fiskio, J. M., Kuperman, G. J., Blumenfeld, B., Recklet, E. G., Bates, D. W., & Gandhi, T. K. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1868 · Cited by 353 · see citing works
Clinical Decision Support Systems Could Be Modified To Reduce ‘Alert Fatigue’ While Still Minimizing The Risk Of Litigation
Kesselheim, A. S., Cresswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.1111 · Cited by 277 · see citing works
Case fatality and population mortality associated with anaphylaxis in the United States
Ma, L., Danoff, T. M., & Borish, L. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.10.029 · Cited by 246 · see citing works
Characteristics and Consequences of Drug Allergy Alert Overrides in a Computerized Physician Order Entry System
Hsieh, T. C., Kuperman, G. J., Jaggi, T., Hojnowski-Diaz, P., Fiskio, J., Williams, D. H., Bates, D. W., & Gandhi, T. K. (2004) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1556 · Cited by 232 · see citing works
A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems
Phansalkar, S., Edworthy, J., Hellier, E., Seger, D. L., Schedlbauer, A., Avery, A. J., & Bates, D. W. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.005264 · Cited by 226 · see citing works
Anaphylaxis: risk factors for recurrence
Mullins, R. J. (2003) · Clinical & Experimental Allergy · doi:10.1046/j.1365-2222.2003.01671.x · Cited by 220 · see citing works
Overrides of medication-related clinical decision support alerts in outpatients
Nanji, K. C., Slight, S. P., Seger, D. L., Cho, I., Fiskio, J. M., Redden, L. M., Volk, L. A., & Bates, D. W. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001813 · Cited by 219 · see citing works
The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication Orders
Jaspers, M., & Khajouei, R. (2009) · Methods of Information in Medicine · doi:10.3414/me0630 · Cited by 187 · see citing works
Medication-related clinical decision support alert overrides in inpatients
Nanji, K. C., Seger, D. L., Slight, S. P., Amato, M. G., Beeler, P. E., Her, Q. L., Dalleur, O., Eguale, T., Wong, A., Silvers, E. R., et al. (2018) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocx115 · Cited by 179 · see citing works
Drug interaction alert override rates in the Meaningful Use era: No evidence of progress
Bryant, A. D., Fletcher, G. S., & Payne, T. H. (2014) · Applied Clinical Informatics · doi:10.4338/aci-2013-12-ra-0103 · Cited by 172 · cited 3× · see citing works
“1 DDI June 10-13, 2013 PTHcc ROS Bryant et al [28]”
Background
A framework for evaluating the appropriateness of clinical decision support alerts and responses
McCoy, A. B., Waitman, L. R., Lewis, J. B., Wright, J. A., Choma, D. P., Miller, R. A., & Peterson, J. F. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000185 · Cited by 138 · see citing works
High-priority drug–drug interactions for use in electronic health records
Phansalkar, S., Desai, A. A., Bell, D., Yoshida, E., Doole, J., Czochanski, M., Middleton, B., & Bates, D. W. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000612 · Cited by 134 · see citing works
Analysis of clinical decision support system malfunctions: a case series and survey
Wright, A., Hickman, T.-T. T., McEvoy, D., Aaron, S., Ai, A., Andersen, J. M., Hussain, S., Ramoni, R., Fiskio, J., Sittig, D. F., et al. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw005 · Cited by 132 · see citing works
Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support
Seidling, H. M., Phansalkar, S., Seger, D. L., Paterno, M. D., Shaykevich, S., Haefeli, W. E., & Bates, D. W. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000039 · Cited by 128 · see citing works
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review
Powers, E. M., Shiffman, R. N., Melnick, E. R., Hickner, A., & Sharifi, M. (2018) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocy112 · Cited by 128 · see citing works
Alert fatigue
Cash, J. J. (2009) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp090181 · Cited by 126 · see citing works
Drug safety alert generation and overriding in a large Dutch university medical centre
van der Sijs, H., Mulder, A., van Gelder, T., Aarts, J., Berg, M., & Vulto, A. (2009) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1800 · Cited by 119 · see citing works
Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience
Topaz, M., Seger, D. L., Slight, S. P., Goss, F. R., Lai, K. H., Wickner, P. G., Blumenthal, K. G., Dhopeshwarkar, N., CHANG, F. Y., Bates, D. W., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv143 · Cited by 116 · see citing works
Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System
Lin, C.-P., Payne, T. H., Nichol, W. P., Hoey, P. J., Anderson, C. L., & Gennari, J. H. (2008) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2453 · Cited by 110 · see citing works
Preventable Medication Errors: Identifying and Eliminating Serious Drug Interactions
Peterson, J. F., & Bates, D. O. (2001) · Journal of the American Pharmaceutical Association (1996) · doi:10.1016/s1086-5802(16)31243-8 · Cited by 106 · see citing works
On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop
Coleman, J., van der Sijs, H., Haefeli, W., Slight, S., Mcdowell, S. E., Seidling, H. M., Eiermann, B., Aarts, J., Ammenwerth, E., Ferner, R., et al. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-111 · Cited by 102 · see citing works
What, if all alerts were specific - estimating the potential impact on drug interaction alert burden
Seidling, H. M., Klein, U., Schaier, M., Czock, D., Theile, D., Pruszydlo, M. G., Kaltschmidt, J., Mikus, G., & Haefeli, W. E. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2013.12.006 · Cited by 91 · see citing works
Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care
Slight, S. P., Seger, D. L., Nanji, K. C., Cho, I., Maniam, N., Dykes, P. C., & Bates, D. W. (2013) · PLoS ONE · doi:10.1371/journal.pone.0085071 · Cited by 86 · see citing works
How to Design Computerized Alerts to Ensure Safe Prescribing Practices
Feldstein, A. C., Simon, S. R., Schneider, J. P., Krall, M., Laferriere, D. S., Smith, D. H., Sittig, D. F., & Soumerai, S. B. (2004) · The Joint Commission Journal on Quality and Safety · doi:10.1016/s1549-3741(04)30071-7 · Cited by 81 · see citing works
Clinician's assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements.
Krall, M., & Sittig, D. F. (2002) · PubMed · Cited by 79 · see citing works
Recommendations for selecting drug–drug interactions for clinical decision support
Tilson, H. H., Hines, L. E., McEvoy, G. K., Weinstein, D. M., Hansten, P. D., Matuszewski, K. A., le Comte, M., Higby-Baker, S., Hanlon, J. T., Pezzullo, L., et al. (2016) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp150565 · Cited by 78 · see citing works
Prospective evaluation of medication-related clinical decision support over-rides in the intensive care unit
Wong, A., Amato, M. G., Seger, D. L., Rehr, C., Wright, A., Slight, S. P., Beeler, P. E., Orav, E. J., & Bates, D. W. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2017-007531 · Cited by 77 · see citing works
Variation in high-priority drug-drug interaction alerts across institutions and electronic health records
McEvoy, D. S., Sittig, D. F., Hickman, T.-T., Aaron, S., Ai, A., Amato, M., Bauer, D. W., Fraser, G. M., Harper, J., Kennemer, A., et al. (2017) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw114 · Cited by 75 · see citing works
Patient-specific electronic decision support reduces prescription of excessive doses
Seidling, H. M., Schmitt, S. P. W., Bruckner, T., Kaltschmidt, J., Pruszydlo, M. G., Senger, C., Bertsche, T., Walter‐Sack, I., & Haefeli, W. E. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2009.033175 · Cited by 71 · see citing works
Development of a context model to prioritize drug safety alerts in CPOE systems
Riedmann, D., Jung, M., Hackl, W. O., Stühlinger, W., van der Sijs, H., & Ammenwerth, E. (2011) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-11-35 · Cited by 70 · see citing works
Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.
Kawamoto, K., & Lobach, D. F. (2003) · PubMed · Cited by 70 · see citing works
Prescriber response to computerized drug alerts for electronic prescriptions among hospitalized patients
Zenziper, Y., Kurnik, D., Matok, I., Halkin, H., Markovits, N., Ziv, A., Shamiss, A., & Loebstein, R. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.08.008 · Cited by 63 · see citing works
Grading the Severity of Drug-Drug Interactions in the Intensive Care Unit: A Comparison Between Clinician Assessment and Proprietary Database Severity Rankings
Smithburger, P. L., Kane‐Gill, S. L., Benedict, N. J., Falcione, B. A., & Seybert, A. L. (2010) · Annals of Pharmacotherapy · doi:10.1345/aph.1p377 · Cited by 62 · see citing works
Structured override reasons for drug-drug interaction alerts in electronic health records
Wright, A., McEvoy, D. S., Aaron, S., McCoy, A. B., Amato, M. G., Kim, H., Ai, A., Cimino, J. J., Desai, B. R., El-Kareh, R., et al. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz033 · Cited by 61 · see citing works
Evaluating the Appropriateness of Digoxin Level Monitoring
Cañas, F., Tanasijevic, M. J., Ma'luf, N., & Bates, D. W. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.4.363 · Cited by 51 · see citing works
Analysis of overridden alerts in a drug-drug interaction detection system
Mille, F., Schwartz, C., Brion, F., Fontan, J.-E., Bourdon, O., Degoulet, P., & Jaulent, M.-C. (2008) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzn038 · Cited by 47 · see citing works
Automated identification of an aspirin-exacerbated respiratory disease cohort
Cahill, K. N., Johns, C. B., Cui, J., Wickner, P. G., Bates, D. W., Laidlaw, T. M., & Beeler, P. E. (2016) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2016.05.048 · Cited by 45 · see citing works
A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement
Slight, S. P., Beeler, P. E., Seger, D. L., Amato, M. G., Her, Q. L., Swerdloff, M., Dalleur, O., Nanji, K. C., Cho, I., Maniam, N., et al. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004851 · Cited by 44 · see citing works
Characteristics of clinical decision support alert overrides in an electronic prescribing system at a tertiary care paediatric hospital
Jani, Y. H., Barber, N., & Wong, I. C. K. (2011) · International Journal of Pharmacy Practice · doi:10.1111/j.2042-7174.2011.00132.x · Cited by 44 · see citing works
Influence of adverse drug events on morbidity and mortality in intensive care units: the JADE study
Ohta, Y., Sakuma, M., Koike, K., Bates, D. W., & Morimoto, T. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu081 · Cited by 42 · see citing works
Evaluation of medication-related clinical decision support alert overrides in the intensive care unit
Wong, A., Amato, M. G., Seger, D. L., Slight, S. P., Beeler, P. E., Dykes, P. C., Fiskio, J. M., Silvers, E. R., Orav, E. J., Eguale, T., et al. (2017) · Journal of Critical Care · doi:10.1016/j.jcrc.2017.02.027 · Cited by 41 · see citing works
Understanding physicians’ behavior toward alerts about nephrotoxic medications in outpatients: a cross-sectional analysis
Cho, I., Slight, S. P., Nanji, K. C., Seger, D. L., Maniam, N., Dykes, P. C., & Bates, D. W. (2014) · BMC Nephrology · doi:10.1186/1471-2369-15-200 · Cited by 33 · see citing works
High Override Rate for Opioid Drug-allergy Interaction Alerts: Current Trends and Recommendations for Future
Topaz, M., Seger, D. L., Lai, K. H., Wickner, P. G., Goss, F. R., Dhopeshwarkar, N., CHANG, F. Y., Bates, D. W., & Zhou, L. (2015) · Studies in health technology and informatics · doi:10.3233/978-1-61499-564-7-242 · Cited by 31 · see citing works
Clinical Decision Support System to Enhance Quality Control of Spirometry Using Information and Communication Technologies
Burgos, F., Melia, U. S. P., Vallverdú, M., Velickovski, F., Lluch-Ariet, M., Caminal, P., & Roca, J. (2014) · JMIR Medical Informatics · doi:10.2196/medinform.3179 · Cited by 27 · see citing works
Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department
Ahn, E. K., Cho, S.-Y., Shin, D., Jang, C., & Park, R. W. (2014) · Healthcare Informatics Research · doi:10.4258/hir.2014.20.4.280 · Cited by 26 · see citing works
Towards improved drug allergy alerts: Multidisciplinary expert recommendations
Topaz, M., Goss, F., Blumenthal, K., Lai, K. H., Seger, D., Slight, S., Wickner, P. G., Robinson, G. A., Fung, K., McClure, R., et al. (2016) · Int. J. Medical Informatics · doi:10.1016/j.ijmedinf.2016.10.006 · Cited by 26 · see citing works
Determining Inappropriate Medication Alerts from “Inaccurate Warning” Overrides in the Intensive Care Unit
Rehr, C., Wong, A., Seger, D. L., & Bates, D. W. (2018) · Applied Clinical Informatics · doi:10.1055/s-0038-1642608 · Cited by 24 · see citing works
A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation
Yang, C.-Y., Lo, Y.-S., Chen, R., & Liu, C. (2018) · JMIR Medical Informatics · doi:10.2196/medinform.9064 · Cited by 22 · see citing works
Evaluation of Harm Associated with High Dose-Range Clinical Decision Support Overrides in the Intensive Care Unit
Wong, A., Rehr, C., Seger, D. L., Amato, M. G., Beeler, P. E., Slight, S. P., Wright, A., & Bates, D. W. (2019) · Drug Safety · doi:10.1007/s40264-018-0756-x · Cited by 21 · cited 5× · see citing works
“Multiple studies have reported that a high frequency of clinically irrelevant alerts (repetitive alerts with minimal clinical value), mediocre functionality (minimal integration among various departments and lack of alerts prioritization), and erroneous assessment by physicians are the main reasons for inappropriate o…”
BackgroundInfluential
Detection and prevention of prescriptions with excessive doses in electronic prescribing systems
Seidling, H. M., Barmawi, A. A., Kaltschmidt, J., Bertsche, T., Pruszydlo, M. G., & Haefeli, W. E. (2007) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-007-0370-9 · Cited by 17 · see citing works
Wide variation and patterns of physicians’ responses to drug–drug interaction alerts
Cho, I., Lee, Y., Lee, J., & Bates, D. W. (2018) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzy102 · Cited by 16 · see citing works
The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting
Her, Q. L., Amato, M. G., Seger, D. L., Beeler, P. E., Slight, S. P., Dalleur, O., Dykes, P. C., Gilmore, J. F., Fanikos, J. R., Fiskio, J. M., et al. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv181 · Cited by 15 · see citing works
Developing strategies for predicting hyperkalemia in potassium-increasing drug-drug interactions
Eschmann, E., Beeler, P. E., Schneemann, M., & Blaser, J. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw050 · Cited by 13 · see citing works
Evaluation of ‘Definite’ Anaphylaxis Drug Allergy Alert Overrides in Inpatient and Outpatient Settings
Wong, A., Seger, D. L., Slight, S. P., Amato, M. G., Beeler, P. E., Fiskio, J. M., & Bates, D. W. (2017) · Drug Safety · doi:10.1007/s40264-017-0615-1 · Cited by 11 · see citing works
Decision support for sensible dosing in electronic prescribing systems
Coleman, J. J., Nwulu, U., & Ferner, R. E. (2011) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2011.01310.x · Cited by 7 · see citing works
Deriving Dose Limits for Warnings in Electronic Prescribing Systems
Coleman, J. J., Hodson, J. A., & Ferner, R. E. (2012) · Drug Safety · doi:10.2165/11594810-000000000-00000 · Cited by 7 · see citing works

Flagged first, then by citations

Research works printed but not linked: 1

[2]Berner E Agency for Healthcare Research and Quality 2009 6 2019-05-08 Clinical decision support systemstate of the art (AHRQ Publication No 09-0069-EF) https://digital.ahrq.gov/sites/default/files/docs/page/09-0069-EF_1.pdf 31145565

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Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review
Raban, M. Z., Gates, P., Gamboa, S., Gonzalez, G., & Westbrook, J. I. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad083 · Cited by 44 · see citing works
Machine Learning Approach to Reduce Alert Fatigue Using a Disease Medication–Related Clinical Decision Support System: Model Development and Validation
Poly, T. N., Islam, M. M., Muhtar, M. S., Yang, H., Nguyen, P., & Li, Y. (2020) · JMIR Medical Informatics · doi:10.2196/19489 · Cited by 44 · see citing works
Self-citation
Optimizing best practice advisory alerts in electronic medical records with a multi-pronged strategy at a tertiary care hospital in Singapore
Ng, H. J. H., Kansal, A., Abdul Naseer, J. F., Hing, W. C., Goh, C. J. M., Poh, H., D’souza, J. L. A., Lim, E. L., & Tan, G. (2023) · JAMIA Open · doi:10.1093/jamiaopen/ooad056 · Cited by 37 · see citing works
Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis
Felisberto, M., Lima, G. D. S., Celuppi, I. C., Fantonelli, M. D. S., Zanotto, W. L., Dias de Oliveira, J. M., Mohr, E. T. B., dos Santos, R. A., Scandolara, D. H., Cunha, C. L., et al. (2024) · Health Informatics Journal · doi:10.1177/14604582241263242 · Cited by 28 · see citing works
An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Biesen, W. V., Cauwenberge, D. V., Decruyenaere, J. M. A., Leune, T., & Sterckx, S. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01933-3 · Cited by 24 · see citing works
The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation—a before-and-after study
Jungreithmayr, V., Meid, A. D., Implementation Team, Bittmann, J. A., Fabian, M., Klein, U., Kugler, S., Löpprich, M., Reinhard, O., Scholz, L., et al. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01607-6 · Cited by 23 · see citing works
Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts
Nguyen, J. Q., Crews, K. R., Moore, B. T., Kornegay, N. M., Baker, D. K., Hasan, M., Campbell, P. K., Dean, S. M., Relling, M. V., Hoffman, J. M., et al. (2022) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocac187 · Cited by 20 · see citing works
Appropriateness of Alerts and Physicians’ Responses With a Medication-Related Clinical Decision Support System: Retrospective Observational Study
Park, H., Chae, M. K., Jeong, W., Yu, J. Y., Jung, W., Chang, H., & Cha, W. C. (2022) · JMIR Medical Informatics · doi:10.2196/40511 · Cited by 19 · see citing works
Learning decision thresholds for risk stratification models from aggregate clinician behavior
Patel, B., Steinberg, E., Pfohl, S. R., & Shah, N. H. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocab159 · Cited by 18 · see citing works
Alert fatigue and errors caused by technology: A scoping review and introduction to the flow of cognitive processing model
Joseph, A. L., Borycki, E. M., Kushniruk, A. W., & |, |. (2021) · Knowledge Management & E-Learning An International Journal · doi:10.34105/j.kmel.2021.13.027 · Cited by 18 · see citing works
Tackling alert fatigue with a semi-automated clinical decision support system: quantitative evaluation and end-user survey
Dahmke, H., Fiumefreddo, R., Schüetz, P., Iaco, R. D., & Zaugg, C. (2023) · Swiss Medical Weekly · doi:10.57187/smw.2023.40082 · Cited by 19 · see citing works
Comparison of potential psychiatric drug interactions in six drug interaction database programs: A replication study after 2 years of updates
Monteith, S., & Glenn, T. (2021) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2802 · Cited by 17 · see citing works
Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Checks: Implementation Study
Jung, S., Bae, S., Seong, D., Oh, O. H., Kim, Y., & Yi, B.-K. (2022) · JMIR Medical Informatics · doi:10.2196/40338 · Cited by 15 · see citing works
Drug interaction alerts in older primary care patients, and related medically justified actions
Tukukino, C., López, N. P., Svensson, S. A., & Wallerstedt, S. M. (2022) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-022-03292-4 · Cited by 15 · see citing works
Modulators Influencing Medication Alert Acceptance: An Explorative Review
Bittmann, J. A., Haefeli, W. E., & Seidling, H. M. (2022) · Applied Clinical Informatics · doi:10.1055/s-0042-1748146 · Cited by 12 · see citing works
Potential Drug-Drug Interactions among Patients with Schizophrenia Spectrum Disorders: Prevalence, Association with Risk Factors, and Replicate Analysis in 2021
Bole, C. B., Nagode, K., Pišlar, M., Mrhar, A., Grabnar, I., & Vovk, T. (2023) · Medicina · doi:10.3390/medicina59020284 · Cited by 12 · see citing works
How intervention studies measure the effectiveness of medication safety-related clinical decision support systems in primary and long-term care: a systematic review
Lampe, D., Grosser, J., Grothe, D., Aufenberg, B., Gensorowsky, D., Witte, J., & Greiner, W. (2024) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-024-02596-y · Cited by 12 · see citing works
Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample
Virtanen, L., Kaihlanen, A., Saukkonen, P., Reponen, J., Lääveri, T., Vehko, T., Saastamoinen, P., Viitanen, J., & Heponiemi, T. (2023) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-023-02351-9 · Cited by 13 · see citing works
Design, development, implementation, and evaluation of a severe drug–drug interaction alert system in the ICU: An analysis of acceptance and override rates
Karajizadeh, M., Zand, F., Vazin, A., Saeidnia, H. R., Lund, B. D., Tummuru, S. P., & Sharifian, R. (2023) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2023.105135 · Cited by 10 · see citing works
Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial
Brünn, R., Lemke, D., Basten, J., Kellermann-Mühlhoff, P., Köberlein–Neu, J., Muth, C., van den Akker, M., & on behalf of the AdAM Study Group (2022) · Pharmaceuticals · doi:10.3390/ph15060759 · Cited by 9 · see citing works
Beyond the override: Using evidence of previous drug tolerance to suppress drug allergy alerts; a retrospective study of opioid alerts
Colicchio, T. K., & Cimino, J. J. (2023) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2023.104508 · Cited by 8 · see citing works
Sustained Effect of Clinical Decision Support for Heart Failure: A Natural Experiment Using Implementation Science
Trinkley, K. E., Wright, G. C., Allen, L. A., Bennett, T. D., Glasgow, R. E., Hale, G., Heckman, S., Huebschmann, A. G., Kahn, M. G., Kao, D. P., et al. (2023) · Applied Clinical Informatics · doi:10.1055/s-0043-1775566 · Cited by 8 · see citing works
Improved diagnosis-medication association mining to reduce pseudo-associations
Wang, C., Nguyễn, P. A., Li, Y., Islam, M. M., Poly, T. N., Tran, Q., Huang, C., & Yang, H. (2021) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2021.106181 · Cited by 8 · see citing works
Self-citation
Clinical Decision Support System Based on Hybrid Knowledge Modeling: A Case Study of Chronic Kidney Disease-Mineral and Bone Disorder Treatment
Ali, S. I., Jung, S. W., Bilal, H. S. M., Lee, S. H., Hussain, J., Afzal, M., Hussain, M., Ali, T., Chung, T., & Lee, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010226 · Cited by 9 · see citing works
Experiences of Alert Fatigue and Its Contributing Factors in Hospitals: Qualitative Study
Newton, N., Bamgboje‐Ayodele, A., Forsyth, R., Tariq, A., Huang, J., Yannam, R., Lalor, D. J., Sobey, A. J., & Baysari, M. T. (2025) · Journal of Medical Internet Research · doi:10.2196/78676 · Cited by 12 · see citing works
Alert fatigue measurement in clinical decision support: a systematic review
Ray, C. E., Wilson, G., Hughes, A. M., Goedken, C. C., Liu, E. P.-F., Fitzpatrick, M. A., Suda, K. J., Kota, S. M., Nwankpa, C., & Evans, C. (2026) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocag064 · Cited by 7 · see citing works
Clinically significant drug interactions between antiretroviral and co-prescribed drugs in HIV infected patients: retrospective cohort study
Alsayed, H. A. H., Sharif‐Askari, N. S., & Rahimi, M. R. (2022) · Medicine and Pharmacy Reports · doi:10.15386/mpr-2305 · Cited by 8 · see citing works
Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals
Alsaidan, J., Portlock, J. C., Ata, S. I., Aljadhey, H. S., & Franklin, B. D. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01838-1 · Cited by 7 · see citing works
Co-prescription of metoprolol and CYP2D6-inhibiting antidepressants before and after implementation of an optimized drug interaction database in Norway
Gedde‐Dahl, A., Spigset, O., & Molden, E. (2022) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-022-03364-5 · Cited by 7 · see citing works
Validation of a novel Artificial Pharmacology Intelligence (API) system for the management of patients with polypharmacy
Dil-Nahlieli, D., Ben‐Yehuda, A., Souroujon, D., Hyam, E., & Shafran-Tikvah, S. (2024) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2024.04.003 · Cited by 7 · see citing works
Development of a Human Factors–Based Guideline to Support the Design, Evaluation, and Continuous Improvement of Clinical Decision Support
Awad, S., Loveday, T., Lau, R., & Baysari, M. T. (2024) · Mayo Clinic Proceedings Digital Health · doi:10.1016/j.mcpdig.2024.11.003 · Cited by 6 · see citing works
Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure
Shakowski, C., Page, R. L., II, Wright, G. C., Lunowa, C., Marquez, C., Suresh, K., Allen, L. A., Glasgow, R. E., Lin, C., Wick, A. T., et al. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad109 · Cited by 6 · see citing works
Interprofessional Evaluation of a Medication Clinical Decision Support System Prior to Implementation
Bauer, J., Busse, M., Kopetzky, T., Seggewies, C., Fromm, M. F., & Dörje, F. (2024) · Applied Clinical Informatics · doi:10.1055/s-0044-1787184 · Cited by 6 · see citing works
The impact of an electronic alert to reduce the risk of co-prescription of low molecular weight heparins and direct oral anticoagulants
Brown, A. H., Cavell, G. F., Dogra, N., & Whittlesea, C. (2022) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2022.104780 · Cited by 6 · see citing works
Electronic alerts in acute kidney injury: why does evidence of benefit remain elusive?
Horne, K. L., Noble, R. A., Karelia, S., & Selby, N. M. (2023) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000921 · Cited by 6 · see citing works
Development and validation of a clinical decision support system to prevent anticoagulant duplications
Dahmke, H., Cabrera-Diaz, F., Heizmann, M., Stoop, S., Schüetz, P., Fiumefreddo, R., & Zaugg, C. (2024) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2024.105446 · Cited by 6 · see citing works
Clinical–pharmaceutical assessment of medication CDSS alerts: content appropriateness and patient relevance in clinical practice
Bauer, J., Busse, M., Koch, S., Schmid, M., Sommer, J. C., Fromm, M. F., & Dörje, F. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1510425 · Cited by 6 · see citing works
A clinical decision support system promotes the appropriate use of drugs in hospitalized patients with kidney impairment
Sonoda, A. (2025) · Journal of Pharmaceutical Health Care and Sciences · doi:10.1186/s40780-025-00431-8 · Cited by 5 · see citing works
Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm
Dahmke, H., Schelshorn, J., Fiumefreddo, R., Schüetz, P., Salili, A. R., Cabrera-Diaz, F., Meyer‐Massetti, C., & Zaugg, C. (2024) · Drugs - Real World Outcomes · doi:10.1007/s40801-023-00405-y · Cited by 5 · see citing works
Optimising interruptive clinical decision support alerts for antithrombotic duplicate prescribing in hospital
Sundermann, M., Clendon, O., McNeill, R., Doogue, M. P., & Chin, P. K. L. (2024) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2024.105418 · Cited by 5 · see citing works
Clinical Usefulness of Drug-Disease Interaction Alerts from a Clinical Decision Support System, MedGuard, for Patient Safety: A Single Center Study
Poly, T. N., Islam, M. M., & Li, Y. (2022) · Studies in health technology and informatics · doi:10.3233/shti220089 · Cited by 5 · see citing works
Self-citation
Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions
Gadhiya, K. P., Zamora, E., Saiyed, S. M., Friedlander, D., & Kaelber, D. C. (2021) · Applied Clinical Informatics · doi:10.1055/s-0041-1729167 · Cited by 5 · see citing works
Editorial: Digital health and prescribing: declare the past, diagnose the present, foretell the future
Austin, J. A., Barras, M. A., & Sullivan, C. M. (2023) · Australian Prescriber · doi:10.18773/austprescr.2023.015 · Cited by 4 · see citing works
Monitoring the Implementation of Tobacco Cessation Support Tools: Using Novel Electronic Health Record Activity Metrics
Chen, J., Cutrona, S. L., Dharod, A., Bunch, S. C., Foley, K. L., Ostasiewski, B., Hale, E. R., Bridges, A., Moses, A., Donny, E. C., et al. (2023) · JMIR Medical Informatics · doi:10.2196/43097 · Cited by 4 · see citing works
“We focused on interruptive alerts because they were more likely to add a “burden” on providers [30-33].”
BackgroundInfluential
Development of knowledge-based clinical decision support system for patients included in colorectal screening program
Lorenzo‐Zúñiga, V., Bustamante, M., Pons, V., & Peña, C. (2021) · Gastroenterología y Hepatología · doi:10.1016/j.gastrohep.2021.05.011 · Cited by 4 · see citing works
Implementation of a clinical decision support alert to prevent use of intravenous β-blockers and nondihydropyridine calcium channel blockers in hospitalized patients with acute decompensated heart failure
Okerberg, C. K., Adie, S. K., Konerman, M. C., & Zimmerman, C. (2023) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxad036 · Cited by 4 · see citing works
Evaluation of appropriateness of alerts overrides and physicians' responses of the medication-related clinical decision support system in China, a hospital-based study
Jin, L., Fang, H., Shen, J., He, Z., Li, Y., Dong, L., Feng, J., & Asakawa, T. (2024) · Drug Discoveries & Therapeutics · doi:10.5582/ddt.2024.01012 · Cited by 4 · see citing works
Self-citation
The Impact of Customized Screening Intervals on the Burden of Drug-Drug Interaction Alerts: An Interrupted Time Series Analysis
Sijpe, G. V. D., Walgraeve, K., Laer, E. V., Quintens, C., Machiels, C., Foulon, V., Casteels, M., der Linden, L. R. V., & Spriet, I. (2024) · Journal of medical systems · doi:10.1007/s10916-024-02113-8 · Cited by 3 · see citing works
Impact of an electronic health record alert on inappropriate prescribing of high-risk medications to patients with concurrent “do not give” orders
Smith, K., Durant, K. M., & Zimmerman, C. (2022) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxac092 · Cited by 4 · see citing works
Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis
Ma, J. E., Lowe, J., Berkowitz, C. M., Kim, A., Togo, I., Musser, R. C., Fischer, J. E., Shah, K., Ibrahim, S., Bosworth, H. B., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/41884 · Cited by 3 · see citing works
Interruptions and Multitasking in Clinical Work: A Summary of the Evidence
Westbrook, J. I., Raban, M. Z., Clive, J., & Walter, S. R. (2025) · Cognitive informatics in biomedicine and healthcare · doi:10.1007/978-3-031-82971-0_9 · Cited by 3 · see citing works
Determinants influencing medication-related alert handling in the electronic health record: A systematic review and meta-analysis
Raven, K., Zhang, J., Vagliano, I., Jaspers, M., Peute, L., & Medlock, S. K. (2025) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2025.106011 · Cited by 3 · see citing works
Examining medication ordering errors using AHRQ network of patient safety databases
Grauer, A., Rosen, A., Applebaum, J. R., Carter, D., Reddy, P., Col, A. K. D., Kumaraiah, D., Barchi, D. J., Classen, D. C., & Adelman, J. S. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad007 · Cited by 3 · see citing works
An Evaluation of Drug-Drug Interaction Alerts Produced by Clinical Decision Support Systems in a Tertiary Hospital
Alanazi, A., alalawi, W., & Aldosari, B. (2023) · Cureus · doi:10.7759/cureus.43141 · Cited by 3 · see citing works
Physicians’ Perspectives on Prescription Alerts: A Journey Towards Reducing Fatigue
Takizawa, M., Nakayama, N., Ohishi, Y., Tanaka, K., Noguchi, R., Saito, Y., Hirano, K., & Komatsu, Y. (2025) · Cureus · doi:10.7759/cureus.86996 · Cited by 2 · see citing works
Clinical decision support systems’ effect in reducing medication errors and adverse drug events: an expanded review from Making Healthcare Safer IV
Syrowatka, A., Motala, A., Lawson, E. K., & Shekelle, P. (2025) · BMJ Digital Health & AI · doi:10.1136/bmjdhai-2025-000083 · Cited by 2 · see citing works
A Retrospective Study on the Impact and Benefits of Commercial Clinical Decision Support Systems in Clinical Decision-Making and Pharmaceutical Care
Wu, L.-H., Liou, I.-L., Yang, Y. K., & Cheng, C.-L. (2025) · Integrated Pharmacy Research and Practice · doi:10.2147/iprp.s526485 · Cited by 2 · see citing works
Real-world evaluation of large language models in detecting drug-related problems: A clinical pharmacist–AI concordance study in hematology care
Demirpolat, E., Tuncel, M. S., Gurer, F., & Şanlı, N. M. (2026) · Journal of Oncology Pharmacy Practice · doi:10.1177/10781552261418957 · Cited by 2 · see citing works
Diagnostic stewardship monitoring systems: institutional and system-level approaches
Park, K. (2026) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2026.2666326 · Cited by 2 · see citing works
Drug Allergy Alert System in a Spanish University Hospital: Description and Dynamics of Use
Rosado-Ingelmo, A., Pastor-Magro, A. B., Pizarro-Jaraiz, M. A., Sanz-Márquez, S., Riádigos, G. M. S., Peña-Acevedo, Y., Tejedor-Alberti, A., & Tejedor-Alonso, M. (2023) · International Archives of Allergy and Immunology · doi:10.1159/000531170 · Cited by 3 · see citing works
Prevalence, contemporary trends and associated factors of potentially inappropriate prescription of edoxaban in real‐world clinical practice: A subanalysis of the SUNSHINE registry
Zhao, S., Dai, H., Chen, J., Ni, M., Peng, W., Li, X., Li, F., Chen, B., Cai, H., Liu, Y., et al. (2023) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.15961 · Cited by 2 · see citing works
Evaluation of Diagnostic Recommendations Embedded in Medication Alerts: Prospective Single-Arm Interventional Study
Liu, Y., Lin, G., Scholl, J., Hung, Y.-C., Lin, Y.-M., Li, Y., & Yang, H. (2025) · Journal of Medical Internet Research · doi:10.2196/70731 · Cited by 1 · see citing works
Self-citation
Management and governance of medication prescribing alerts among hospitals in Japan: a nationwide survey
Nakayama, N., Takizawa, M., Ohishi, Y., Komatsu, Y., & Tanaka, K. (2025) · BMJ Open Quality · doi:10.1136/bmjoq-2024-003253 · Cited by 1 · see citing works
The impact of patient information on prescribing errors: Insights from pharmaceutical interventions
Koike, D., Ito, M., Tomomatsu, K., Shindo, R., Miyashita, T., Yamakami, J., Horiguchi, A., & Yamada, S. (2025) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2025.100665 · Cited by 1 · see citing works
Duplicate Prescription Patterns in Patients With Substance Use Disorders
Heck, J., Krichevsky, B., Westhoff, M. S., Jendretzky, K. F., Klietz, M., Greten, S., Glahn, A., Bleich, S., & Schröder, S. (2025) · Pharmacology Research & Perspectives · doi:10.1002/prp2.70211 · Cited by 1 · see citing works
Factors affecting drug interactions and their clinical importance in geriatric outpatients
Arun, M. Z., YILDIZ, İ. Z., Taşkıran, E., Şahin, S., & Ertuna, E. (2023) · The Turkish Journal of Geriatrics · doi:10.29400/tjgeri.2023.336 · Cited by 1 · see citing works
Impact of Redesign of a Clinical Decision Allergy and Drug Interactions Alerts in an Electronic Prescribing System on Patient Safety – A Quantitative Descriptive Study
Khalil, V., & Hua, A. (2021) · International Journal of Digital Health · doi:10.29337/ijdh.40 · Cited by 1 · see citing works
Computerized Clinical Decision Support
Shirazian, S., Maesaka, J. K., Imbriano, L. J., & Mattana, J. (2022) · Springer eBooks · doi:10.1007/978-3-030-86020-2_22 · Cited by 1 · see citing works
Development of knowledge-based clinical decision support system for patients included in colorectal screening program
Lorenzo‐Zúñiga, V., Bustamante, M., Pons, V., & Peña, C. (2022) · Gastroenterología y Hepatología (English Edition) · doi:10.1016/j.gastre.2021.05.008
Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Check: Implementation Study (Preprint)Preprint
Yi, B.-K., Jung, S., Bae, S., Seong, D., Oh, O. H., & Kim, Y. (2022) · doi:10.2196/preprints.40338
Appropriateness of Alerts and Physicians’ Responses with a Medication-related Clinical Decision Support System (Preprint)Preprint
Park, H., Chae, M. K., Jeong, W., Yu, J. Y., Jung, W., Chang, H., & Cha, W. C. (2022) · doi:10.2196/preprints.40511
Evaluation of clinical decision support
Benson, N. M., Salmasian, H., & Bates, D. W. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-91200-6.00026-7
Physicians' acceptance of drug-drug interaction alerts from clinical decision support systems: A systematic review and meta-analysisPreprint
Felisberto, M., Lima, G. D. S., Celuppi, I. C., Fantonelli, M. D. S., Zanotto, W. L., de Oliveira, J. M. D., Mohr, E. T. B., Santos, R. A., Scandolara, D. H., Cunha, C. L., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2977577/v1
Cloud-Based Medication Non-adherence Assessment and Intervention System
Julius, M. S., Alo, U. R., Onu, F. U., Akobundu, C. I., Agwu, C. O., Ogbu, N. H., & Eze, F. C. (2024) · Lecture notes in networks and systems · doi:10.1007/978-981-97-3559-4_52
Allergy alerting and overrides for opioid analogues across two health systems
Wasserman, R. L., Goss, F., Seger, D., Blumenthal, K. G., Lo, Y., Edrees, H. H., Varghese, S., Wang, L.-Q., Blackley, S. V., Bates, D. W., et al. (2025) · BMJ Health & Care Informatics · doi:10.1136/bmjhci-2024-101259
A Systematic Approach to Screen, Identify, and Correct Malfunctioning Interruptive Alerts
Wahsh, E. A., Juskewitch, J. E., Eichenlaub, C., Holbrook, C., & Caraballo, P. J. (2025) · Applied Clinical Informatics · doi:10.1055/a-2646-6297
High effectiveness of the digitalization of the GESIDA clinical guideline for HIV patient management
Montosa-i-Micó, V., Tortajada, C., Batet, Á. N., Castillo, R. A., Camacho, M., Perez, D. R., García, D. S., & Garcia-Gomez, J. M. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13669-7
Exploring Alert Fatigue, Mitigation Strategies, and Enhancing Drug-Drug Interaction Alert Acceptance: A Systematic Review and Meta-Analysis (Preprint)Preprint
O’Sullivan, C., Starkey, T., & Pirmohamed, M. (2025) · doi:10.2196/preprints.88578 · Cited by 1 · see citing works
Reducing incorrect antibiotic dosing and enhancing prescriber adherence through a real‐time, patient‐specific clinical decision support system: A post‐implementation evaluation
Liang, S., Liang, C., Chen, W., Huang, C., Lai, C., Lin, I., Chang, H., Hsu, Y., Yeh, C., Chang‐Chien, P., et al. (2025) · British Journal of Clinical Pharmacology · doi:10.1002/bcp.70397
Pharmacist-Led Optimization of High-Alert Medications in Critical Care Settings
Alreshidi, H. M. N., Alreshidi, A. A. T., Alshilash, I. A., Alhamili, M. N. M., Albalawi, A. O. S., Alasmari, S. A. S., Almsaudi, B. S., Albalawi, B. S., Alruwaili, M. A. S., Alenezi, K. A. T., et al. (2024) · International Journal of Computational and Experimental Science and Engineering · doi:10.22399/ijcesen.4484
Additional file 5 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218954
Additional file 1 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218936
Additional file 6 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218957
Additional file 2 of How intervention studies measure the effectiveness of medication safety-related clinical decision support systems in primary and long-term care: a systematic review
Lampe, D., Grosser, J., Grothe, D., Aufenberg, B., Gensorowsky, D., Witte, J., & Greiner, W. (2024) · Figshare · doi:10.6084/m9.figshare.26743355
Additional file 3 of How intervention studies measure the effectiveness of medication safety-related clinical decision support systems in primary and long-term care: a systematic review
Lampe, D., Grosser, J., Grothe, D., Aufenberg, B., Gensorowsky, D., Witte, J., & Greiner, W. (2024) · Figshare · doi:10.6084/m9.figshare.26743358
Additional file 4 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218948
Additional file 2 of Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample
Virtanen, L., Kaihlanen, A.-M., Saukkonen, P., Reponen, J., Lääveri, T., Vehko, T., Saastamoinen, P., Viitanen, J., & Heponiemi, T. (2024) · Figshare · doi:10.6084/m9.figshare.26637348
Additional file 1 of How intervention studies measure the effectiveness of medication safety-related clinical decision support systems in primary and long-term care: a systematic review
Lampe, D., Grosser, J., Grothe, D., Aufenberg, B., Gensorowsky, D., Witte, J., & Greiner, W. (2024) · Figshare · doi:10.6084/m9.figshare.26743352
Additional file 1 of Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample
Virtanen, L., Kaihlanen, A.-M., Saukkonen, P., Reponen, J., Lääveri, T., Vehko, T., Saastamoinen, P., Viitanen, J., & Heponiemi, T. (2024) · Figshare · doi:10.6084/m9.figshare.26637345
Additional file 3 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218945
Additional file 2 of An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Van Biesen, W., Cauwenberge, D. V., Decruyenaere, J., Leune, T., & Sterckx, S. (2022) · Figshare · doi:10.6084/m9.figshare.20330073
Additional file 3 of An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Van Biesen, W., Cauwenberge, D. V., Decruyenaere, J., Leune, T., & Sterckx, S. (2022) · Figshare · doi:10.6084/m9.figshare.20330076
Additional file 4 of An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Van Biesen, W., Cauwenberge, D. V., Decruyenaere, J., Leune, T., & Sterckx, S. (2022) · Figshare · doi:10.6084/m9.figshare.20330079
Additional file 5 of An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Van Biesen, W., Cauwenberge, D. V., Decruyenaere, J., Leune, T., & Sterckx, S. (2022) · Figshare · doi:10.6084/m9.figshare.20330082
Additional file 1 of An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approach
Van Biesen, W., Cauwenberge, D. V., Decruyenaere, J. M. A., Leune, T., & Sterckx, S. (2022) · Figshare · doi:10.6084/m9.figshare.20330070
Additional file 2 of Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Sijpe, G. V. D., Quintens, C., Walgraeve, K., laer, E. V., Penny, J., Vlieger, G. D., Schrijvers, R., Munter, P. D., Foulon, V., Casteels, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19218939

Medication Errors and Patient Safety: Evaluation of Physicians’ Responses to Medication-Related Alert Overrides in Clinical Decision Support Systems
Justinia, T., Qattan, W., Almenhali, A., Abo-Khatwa, A., Alharbi, O. A., & Alharbi, T. (2021) · Acta Informatica Medica · doi:10.5455/aim.2021.29.248-252 · Cited by 16 · see citing works
Overrides of medication-related clinical decision support alerts in outpatients
Nanji, K. C., Slight, S. P., Seger, D. L., Cho, I., Fiskio, J. M., Redden, L. M., Volk, L. A., & Bates, D. W. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001813 · Cited by 219 · see citing works
Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis
Felisberto, M., Lima, G. D. S., Celuppi, I. C., Fantonelli, M. D. S., Zanotto, W. L., Dias de Oliveira, J. M., Mohr, E. T. B., dos Santos, R. A., Scandolara, D. H., Cunha, C. L., et al. (2024) · Health Informatics Journal · doi:10.1177/14604582241263242 · Cited by 28 · see citing works
Retrospective descriptive assessment of clinical decision support medication-related alerts in two Saudi Arabian hospitals
Alsaidan, J., Portlock, J. C., Ata, S. I., Aljadhey, H. S., & Franklin, B. D. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01838-1 · Cited by 7 · see citing works
Overriding Drug-Drug Interaction Alerts in Clinical Decision Support Systems: A Scoping Review
Zapata, L. V., Subbian, V., Boyce, R. D., Hansten, P. D., Horn, J. R., Gephart, S. M., Romero, A. V., & Malone, D. C. (2022) · Studies in health technology and informatics · doi:10.3233/shti220101 · Cited by 28 · see citing works

Authors: Poly, T. N., Islam, M. M., Yang, H.-C., & Li, Y.-C. (.
Affiliations: Wan Fang Hospital (TW)
Corresponding author: Li, Yu-Chuan (Jack)
ORCID: Poly, Tahmina Nasrin
Islam, Md.Mohaimenul
Yang, Hsuan-Chia
Li, Yu-Chuan (Jack)
Venue: JMIR Medical Informatics
Publisher: JMIR Publications Inc.
Published: 2020-07-20
Volume: 8
Issue: 7
Pages: e15653
ISSN: 2291-9694 (ISSN-L)
DOI: 10.2196/15653
PMC: PMC7400042
OpenAlex: W3014693099
Cited by: 118
References: 64
Citations by year: 2026: 19 · 2025: 18 · 2024: 19 · 2023: 21 · 2022: 29 · 2021: 10 · 2020: 2
FWCI: 2.36
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR Medical Informatics (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Ministry of Education, India
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: clinical decision support systems, computerized physician order entry, alert override, alarm fatigue, drug-drug interaction alerts, drug allergy alerts, medication errors, patient safety

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Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review

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