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Table 1 Identified knowledge gaps in the research on CDS alerts

From: On the alert: future priorities for alerts in clinical decision support for computerized physician order entry identified from a European workshop

Research gap Comments
1. Sensitivity and specificity of a CDS system It is unclear whether there is an ideal sensitivity and specificity of a CDS system or whether there is an optimum number of alerts within a system.
2. Presentation and personalization of alerts The best strategies for contextualizing, presenting and filtering alerts for users are still uncertain.
3. Timing of alerts The appropriate point in the workflow process for alerting users needs to be determined.
4. Relevance of the outcome measures in the study of alerts Studies on effects of alerts often include surrogate markers instead of patient parameters as outcome measures.
5. Measurement of the quality of alerts The criteria by which the quality of an alert is judged or whether an alert adds value to a system have not been defined.
6. Design and firing of alerts/rules A systematic approach to the generation of alerts has never been explicitly described.
7. Legal issues The legal implications in the study of alert fatigue are yet to be established. This has been, however, discussed in an American context [35], with particular emphasis on the liability implications of CDS with drug–drug interactions [36, 37].
8. Human factors and usability More investigation of the interaction between users and CDS systems is needed.