Table 1 Identified knowledge gaps in the research on CDS alerts
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. |