{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:56:32Z","timestamp":1761720992665,"version":"build-2065373602"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["5R01DK116898"],"award-info":[{"award-number":["5R01DK116898"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinical decision support (CDS) systems have been widely adopted across clinical settings to promote evidence-based practice for clinicians. CDS malfunctions often affect the user experience and indirectly or directly interfere with patient care. To enhance optimal performance, it is critical to constantly monitor the performance of the tool and react promptly when malfunctions are identified.<\/jats:p>\n                  <jats:p>This study aimed to describe malfunctions identified in the development and implementation of a CDS alert as well as lessons learned.<\/jats:p>\n                  <jats:p>A pragmatic randomized controlled trial of a CDS alert for primary care patients with chronic kidney disease and uncontrolled blood pressure was conducted. The alert included prechecked default orders for medication initiation or titration, basic metabolic panel, and nephrology electronic consult. Alert monitoring involved retrospective chart review and review of alert firing reports.<\/jats:p>\n                  <jats:p>Eight CDS malfunctions were identified. The most common causes of malfunctions were due to conceptualization and build errors. Provider feedback and retrospective chart review were the primary methods of identifying the root cause of malfunctions.<\/jats:p>\n                  <jats:p>Our findings highlight the need for CDS interventions to be continuously monitored through chart review, alert firing reports, and opportunities for provider feedback. Lessons learned from CDS malfunctions can be implemented to improve provider trust in automated electronic health record-based alerts, reduce administrative burden, and prevent inappropriate alert recommendations that can negatively affect patient outcomes. This study is registered with Clinivaltrials.gov (identifier: NCT03679247).<\/jats:p>","DOI":"10.1055\/a-2702-6872","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:26:25Z","timestamp":1761697585000},"page":"1457-1464","source":"Crossref","is-referenced-by-count":0,"title":["Applying an Empirical Taxonomy to Alert Malfunctions in a Pragmatic Trial for Hypertension Management in Chronic Kidney Disease"],"prefix":"10.1055","volume":"16","author":[{"given":"Sarah W.","family":"Chen","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Gannon","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Eastern Virginia Medical School, Norfolk, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John L.","family":"Kilgallon","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Hackensack Meridian School of Medicine, Nutley, New Jersey, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weng Ian","family":"Chay","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Rubins","sequence":"additional","affiliation":[{"name":"Mass General Brigham, Somerville, Massachusetts, United States"},{"name":"Department of General Medicine, Beth Israel Lahey Health, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hojjat","family":"Salmasian","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayon","family":"Dutta","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, United States"},{"name":"Massachusetts General Hospital, Boston, Massachusetts, United States"},{"name":"Department of Emergency Medicine, Massachusetts General Brigham Digital, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin S.","family":"McEvoy","sequence":"additional","affiliation":[{"name":"Trinity Health, Livonia, Michigan, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Department of Urology, Maimonides Medical Center, Brooklyn, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"McCoy","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lipika","family":"Samal","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","article-title":"An overview of clinical decision support systems: benefits, risks, and strategies for success","volume":"3","author":"R T Sutton","year":"2020","journal-title":"NPJ Digit Med"},{"issue":"04","key":"ref2","first-page":"38","article-title":"Implementation pearls from a new guidebook on improving medication use and outcomes with clinical decision support. 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