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Appl Clin Inform 2025; 16(05): 1720-1727
DOI: 10.1055/a-2644-7250
Special Issue on CDS Failures

A Two-Phase Framework Leveraging User Feedback and Systemic Validation to Improve Post-Live Clinical Decision Support

Authors

  • Wendi Zhao

    1   Department of Infection Prevention and Control, Fraser Health Authority, Surrey, BC, Canada

  • Xuetao Wang

    1   Department of Infection Prevention and Control, Fraser Health Authority, Surrey, BC, Canada

  • Kevin Afra

    2   Department of Infection Prevention and Control/Antimicrobial Stewardship, Fraser Health Authority, Surrey, BC, Canada
    3   Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

Funding None.
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Abstract

Objectives

Despite the benefits of clinical decision support (CDS), concerns of potential risks arise amidst increasing reports of CDS malfunctions. Without objective and standardized methods to evaluate CDS in the post-live stage, CDS performance in a dynamic healthcare environment remains a black box from the user's perspective. In this study, we proposed a comprehensive framework to identify and evaluate post-live CDS malfunctions from the perspective of healthcare settings.

Methods

We developed a two-phase framework to identify and evaluate post-live CDS system malfunctions: (1) real-time feedback from users in healthcare settings; (2) systematic validation through the use of databases that involve fundamental data flow validation and knowledge and rules validation. Identity, completeness, plausibility, and consistency across locations and time patterns were included as measures for systematic validation. We applied this framework to a commercial CDS system in 14 acute care facilities in Canada in a 2-year period.

Results

During this study, seven types of malfunctions were identified. The general rate of malfunctions was below 2%. In addition, an increase in CDS malfunctions was found during the electronic health record upgrade and implementation periods.

Conclusion

This framework can be used to comprehensively evaluate CDS performance for healthcare settings. It provides objective insights into the extent of CDS issues, with the ability to capture low-prevalence malfunctions. Applying this framework to CDS evaluation can help improve CDS performance from the perspective of healthcare settings.

Keywords

clinical decision support - methodologies - error management and prevention - quality

Protection of Human and Animal Subjects

This study is a quality-assurance project used exclusively for assessment, management, and improvement purposes; thus does not require research ethics board review.


Supplementary Material



Publication History

Received: 17 December 2024

Accepted: 27 June 2025

Accepted Manuscript online:
30 June 2025

Article published online:
14 November 2025

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