目的:对描述基于规则的临床决策支持(CDS)故障的研究进行范围审查。
方法:2022年4月,我们检索了三个书目数据库(MEDLINE,CINAHL,和Embase)引用CDS故障的文献。我们根据现有的CDS故障分类对识别出的故障进行了编码,并为尚未捕获的因素添加了新的类别。我们还提取和总结了与CDS系统相关的信息,比如建筑,数据源,和数据格式。
结果:28篇文章符合纳入标准,捕获130个故障。使用的架构包括独立系统(例如,基于网络的计算器),集成系统(例如,最佳实践警报),和面向服务的体系结构(例如,分布式系统,如SMART或CDSHooks)。没有发现基于标准的CDS故障。原始分类法的“原因”类别包括三种新类型(组织策略、硬件错误,和数据源)和两个现有的原因被扩展到包括额外的层。只有29个故障(22%)描述了故障对患者护理的潜在影响。
结论:虽然存在大量关于CDS的研究,我们的审查表明,对CDS故障的关注有限,对与SMART和CDSHooks等现代交付架构相关的故障的关注甚至更少。
结论:CDS故障可以并且确实发生在几种不同的护理交付架构中。考虑到卫生信息技术的进步,CDS故障的现有分类必须不断更新。这对于面向服务的体系结构尤其重要,连接几个不同的系统,并且正在增加使用。
OBJECTIVE: Conduct a scoping review of research studies that describe rule-based clinical decision support (CDS) malfunctions.
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.
CONCLUSIONS: 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.
CONCLUSIONS: 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.