Abstract

BackgroundClinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB.MethodsOne hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured.ResultsCompared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB.ConclusionsThis study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.

Highlights

  • Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk

  • The electronic prescription of medicines (e-prescribing) is routine, [1] making the clinical decision support (CDS) systems they include [2] amongst the most common encountered by clinicians

  • With Automation bias (AB) omission errors, users fail to notice problems because they were not alerted to the problem by CDS, and with commission errors, users comply with incorrect recommendations [7]

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Summary

Introduction

Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Over-reliance on alerts may cause clinicians to avoid prescribing particular medicines due to inappropriate alerts or clinicians may fail to detect prescribing errors with the potential for harm because they were not alerted to them. This over-reliance on CDS is referred to as automation bias (AB), and is defined as “the tendency to use automated cues (such as CDS alerts) as a heuristic replacement for vigilant information seeking and processing [7].”.

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