Medical Malpractice

The Institute of Medicine's landmark 1999 report on patient safety, To Err is Human (PDF), estimated that medical errors may be responsible for as many as 98,000 deaths in the United States each year and may cost the health care system up to $29 billion. A substantial number of these errors are medication errors. When prescribed inappropriately, medications can cause serious harm—including drug-drug interactions that can be lethal.

Computerized clinical decision support (CDS) systems have been developed to enhance physician decision-making and to reduce the incidence of avoidable medical errors. Drug-drug interaction warnings are a mainstay of clinical decision support systems, but they give rise to a fundamental problem that has limited much of the utility of those systems to date.

Clinical decision support (CDS) refers to electronic technology used to enhance clinical decision making. For example, computerized physician order entry with integrated CDS in principle offers an electronic layer of review for ordering prescriptions.

An important feature of CDS is automated warnings issued whenever potential drug interactions or other contraindications arise. In practice, however, CDS systems often have been overinclusive in the warnings they generate, to a point at which physician "alert fatigue" may in large part undermine the utility the systems offer....