{"id":"https://openalex.org/W2932132514","doi":"https://doi.org/10.1055/s-0039-1683985","title":"Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study","display_name":"Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study","publication_year":2019,"publication_date":"2019-03-01","ids":{"openalex":"https://openalex.org/W2932132514","doi":"https://doi.org/10.1055/s-0039-1683985","mag":"2932132514","pmid":"https://pubmed.ncbi.nlm.nih.gov/30943572"},"language":"en","primary_location":{"id":"doi:10.1055/s-0039-1683985","is_oa":true,"landing_page_url":"https://doi.org/10.1055/s-0039-1683985","pdf_url":"http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0039-1683985.pdf","source":{"id":"https://openalex.org/S187139995","display_name":"Applied Clinical Informatics","issn_l":"1869-0327","issn":["1869-0327"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320000","host_organization_name":"Thieme Medical Publishers (Germany)","host_organization_lineage":["https://openalex.org/P4310320000"],"host_organization_lineage_names":["Thieme Medical Publishers (Germany)"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Applied Clinical Informatics","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"bronze","oa_url":"http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0039-1683985.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5058204414","display_name":"Jeritt G. Thayer","orcid":"https://orcid.org/0000-0002-9202-539X"},"institutions":[{"id":"https://openalex.org/I1335321130","display_name":"Children's Hospital of Philadelphia","ror":"https://ror.org/01z7r7q48","country_code":"US","type":"funder","lineage":["https://openalex.org/I1335321130"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jeritt Thayer","raw_affiliation_strings":["Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I1335321130"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5044632700","display_name":"Jeffrey M. Miller","orcid":"https://orcid.org/0000-0002-2206-9311"},"institutions":[{"id":"https://openalex.org/I1335321130","display_name":"Children's Hospital of Philadelphia","ror":"https://ror.org/01z7r7q48","country_code":"US","type":"funder","lineage":["https://openalex.org/I1335321130"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jeffrey Miller","raw_affiliation_strings":["Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I1335321130"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5007545587","display_name":"Alexander G. Fiks","orcid":"https://orcid.org/0000-0001-6525-8764"},"institutions":[{"id":"https://openalex.org/I1335321130","display_name":"Children's Hospital of Philadelphia","ror":"https://ror.org/01z7r7q48","country_code":"US","type":"funder","lineage":["https://openalex.org/I1335321130"]},{"id":"https://openalex.org/I79576946","display_name":"University of Pennsylvania","ror":"https://ror.org/00b30xv10","country_code":"US","type":"education","lineage":["https://openalex.org/I79576946"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alexander Fiks","raw_affiliation_strings":["Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I1335321130"]},{"raw_affiliation_string":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I79576946"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032989462","display_name":"Linda Tague","orcid":null},"institutions":[{"id":"https://openalex.org/I1335321130","display_name":"Children's Hospital of Philadelphia","ror":"https://ror.org/01z7r7q48","country_code":"US","type":"funder","lineage":["https://openalex.org/I1335321130"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Linda Tague","raw_affiliation_strings":["Department of Information Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Information Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I1335321130"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5011994567","display_name":"Robert W. Grundmeier","orcid":"https://orcid.org/0000-0002-8290-5588"},"institutions":[{"id":"https://openalex.org/I1335321130","display_name":"Children's Hospital of Philadelphia","ror":"https://ror.org/01z7r7q48","country_code":"US","type":"funder","lineage":["https://openalex.org/I1335321130"]},{"id":"https://openalex.org/I79576946","display_name":"University of Pennsylvania","ror":"https://ror.org/00b30xv10","country_code":"US","type":"education","lineage":["https://openalex.org/I79576946"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Robert Grundmeier","raw_affiliation_strings":["Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I1335321130"]},{"raw_affiliation_string":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States","institution_ids":["https://openalex.org/I79576946"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":1.9711,"has_fulltext":true,"cited_by_count":13,"citation_normalized_percentile":{"value":0.89145003,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":94,"max":98},"biblio":{"volume":"10","issue":"02","first_page":"237","last_page":"246"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.9711999893188477,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.9711999893188477,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13248","display_name":"Healthcare Technology and Patient Monitoring","score":0.009200000204145908,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.0019000000320374966,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/workaround","display_name":"Workaround","score":0.7976787090301514},{"id":"https://openalex.org/keywords/workflow","display_name":"Workflow","score":0.7804809808731079},{"id":"https://openalex.org/keywords/vendor","display_name":"Vendor","score":0.607896625995636},{"id":"https://openalex.org/keywords/context","display_name":"Context (archaeology)","score":0.6029582619667053},{"id":"https://openalex.org/keywords/personalization","display_name":"Personalization","score":0.5309414863586426},{"id":"https://openalex.org/keywords/patient-safety","display_name":"Patient safety","score":0.5240626335144043},{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.4990808963775635},{"id":"https://openalex.org/keywords/clinical-decision-support-system","display_name":"Clinical decision support system","score":0.46554455161094666},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.3982018828392029},{"id":"https://openalex.org/keywords/decision-support-system","display_name":"Decision support system","score":0.36103713512420654},{"id":"https://openalex.org/keywords/process-management","display_name":"Process management","score":0.3403770625591278},{"id":"https://openalex.org/keywords/world-wide-web","display_name":"World Wide Web","score":0.3107413649559021},{"id":"https://openalex.org/keywords/database","display_name":"Database","score":0.25737500190734863},{"id":"https://openalex.org/keywords/business","display_name":"Business","score":0.14140895009040833}],"concepts":[{"id":"https://openalex.org/C194541083","wikidata":"https://www.wikidata.org/wiki/Q457174","display_name":"Workaround","level":2,"score":0.7976787090301514},{"id":"https://openalex.org/C177212765","wikidata":"https://www.wikidata.org/wiki/Q627335","display_name":"Workflow","level":2,"score":0.7804809808731079},{"id":"https://openalex.org/C2777338717","wikidata":"https://www.wikidata.org/wiki/Q1762621","display_name":"Vendor","level":2,"score":0.607896625995636},{"id":"https://openalex.org/C2779343474","wikidata":"https://www.wikidata.org/wiki/Q3109175","display_name":"Context (archaeology)","level":2,"score":0.6029582619667053},{"id":"https://openalex.org/C183003079","wikidata":"https://www.wikidata.org/wiki/Q1000371","display_name":"Personalization","level":2,"score":0.5309414863586426},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.5240626335144043},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4990808963775635},{"id":"https://openalex.org/C63527458","wikidata":"https://www.wikidata.org/wiki/Q5133829","display_name":"Clinical decision support system","level":3,"score":0.46554455161094666},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.3982018828392029},{"id":"https://openalex.org/C107327155","wikidata":"https://www.wikidata.org/wiki/Q330268","display_name":"Decision support system","level":2,"score":0.36103713512420654},{"id":"https://openalex.org/C195094911","wikidata":"https://www.wikidata.org/wiki/Q14167904","display_name":"Process management","level":1,"score":0.3403770625591278},{"id":"https://openalex.org/C136764020","wikidata":"https://www.wikidata.org/wiki/Q466","display_name":"World Wide Web","level":1,"score":0.3107413649559021},{"id":"https://openalex.org/C77088390","wikidata":"https://www.wikidata.org/wiki/Q8513","display_name":"Database","level":1,"score":0.25737500190734863},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.14140895009040833},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0},{"id":"https://openalex.org/C199360897","wikidata":"https://www.wikidata.org/wiki/Q9143","display_name":"Programming language","level":1,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.0},{"id":"https://openalex.org/C162853370","wikidata":"https://www.wikidata.org/wiki/Q39809","display_name":"Marketing","level":1,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C151730666","wikidata":"https://www.wikidata.org/wiki/Q7205","display_name":"Paleontology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D000068598","descriptor_name":"Data Accuracy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068598","descriptor_name":"Data Accuracy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000068598","descriptor_name":"Data Accuracy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D015203","descriptor_name":"Reproducibility of Results","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D015203","descriptor_name":"Reproducibility of Results","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D015203","descriptor_name":"Reproducibility of Results","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D020000","descriptor_name":"Decision Support Systems, Clinical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020000","descriptor_name":"Decision Support Systems, Clinical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020000","descriptor_name":"Decision Support Systems, Clinical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020407","descriptor_name":"Internet","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020407","descriptor_name":"Internet","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D020407","descriptor_name":"Internet","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D057188","descriptor_name":"Workflow","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D057188","descriptor_name":"Workflow","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D057188","descriptor_name":"Workflow","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D057286","descriptor_name":"Electronic Health Records","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D057286","descriptor_name":"Electronic Health Records","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D057286","descriptor_name":"Electronic Health Records","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1055/s-0039-1683985","is_oa":true,"landing_page_url":"https://doi.org/10.1055/s-0039-1683985","pdf_url":"http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0039-1683985.pdf","source":{"id":"https://openalex.org/S187139995","display_name":"Applied Clinical Informatics","issn_l":"1869-0327","issn":["1869-0327"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320000","host_organization_name":"Thieme Medical Publishers (Germany)","host_organization_lineage":["https://openalex.org/P4310320000"],"host_organization_lineage_names":["Thieme Medical Publishers (Germany)"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Applied Clinical Informatics","raw_type":"journal-article"},{"id":"pmid:30943572","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/30943572","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Applied clinical informatics","raw_type":null},{"id":"pmh:oai:europepmc.org:5991461","is_oa":false,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/6447398","pdf_url":null,"source":{"id":"https://openalex.org/S4306400806","display_name":"Europe PMC (PubMed Central)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":"https://openalex.org/I1303153112","host_organization_name":"European Bioinformatics Institute","host_organization_lineage":["https://openalex.org/I1303153112"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Text"}],"best_oa_location":{"id":"doi:10.1055/s-0039-1683985","is_oa":true,"landing_page_url":"https://doi.org/10.1055/s-0039-1683985","pdf_url":"http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0039-1683985.pdf","source":{"id":"https://openalex.org/S187139995","display_name":"Applied Clinical Informatics","issn_l":"1869-0327","issn":["1869-0327"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310320000","host_organization_name":"Thieme Medical Publishers (Germany)","host_organization_lineage":["https://openalex.org/P4310320000"],"host_organization_lineage_names":["Thieme Medical Publishers (Germany)"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Applied Clinical Informatics","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.47999998927116394,"display_name":"Peace, Justice and strong institutions","id":"https://metadata.un.org/sdg/16"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W2932132514.pdf","grobid_xml":"https://content.openalex.org/works/W2932132514.grobid-xml"},"referenced_works_count":54,"referenced_works":["https://openalex.org/W30038292","https://openalex.org/W1482197710","https://openalex.org/W1535516115","https://openalex.org/W1557496348","https://openalex.org/W1787211267","https://openalex.org/W1877492136","https://openalex.org/W1909620779","https://openalex.org/W1969129400","https://openalex.org/W1972617632","https://openalex.org/W1993893903","https://openalex.org/W2000432540","https://openalex.org/W2006128682","https://openalex.org/W2030246418","https://openalex.org/W2030832629","https://openalex.org/W2033121310","https://openalex.org/W2035545097","https://openalex.org/W2037146600","https://openalex.org/W2043033750","https://openalex.org/W2045170614","https://openalex.org/W2050857070","https://openalex.org/W2051842656","https://openalex.org/W2060430759","https://openalex.org/W2070071510","https://openalex.org/W2072866273","https://openalex.org/W2078310328","https://openalex.org/W2080422995","https://openalex.org/W2090725026","https://openalex.org/W2098044946","https://openalex.org/W2107097633","https://openalex.org/W2107539960","https://openalex.org/W2136375912","https://openalex.org/W2145678224","https://openalex.org/W2160382101","https://openalex.org/W2162190913","https://openalex.org/W2167549250","https://openalex.org/W2168700574","https://openalex.org/W2220205265","https://openalex.org/W2276530525","https://openalex.org/W2330482840","https://openalex.org/W2335459508","https://openalex.org/W2623779367","https://openalex.org/W2753858911","https://openalex.org/W2766597844","https://openalex.org/W2802050075","https://openalex.org/W4232243463","https://openalex.org/W4237104182","https://openalex.org/W4240556082","https://openalex.org/W4241434534","https://openalex.org/W4250796155","https://openalex.org/W4255509393","https://openalex.org/W6658086549","https://openalex.org/W6661388313","https://openalex.org/W6661940966","https://openalex.org/W6681698165"],"related_works":["https://openalex.org/W4381612620","https://openalex.org/W2950380533","https://openalex.org/W2998499456","https://openalex.org/W2893207040","https://openalex.org/W3127868735","https://openalex.org/W1840516357","https://openalex.org/W2753986652","https://openalex.org/W4387616455","https://openalex.org/W971576836","https://openalex.org/W2277700187"],"abstract_inverted_index":{"BACKGROUND:":[0],"With":[1],"the":[2,22,26,32,47,56,61,88,133,140,153,192,198,234],"widespread":[3],"adoption":[4],"of":[5,28,50,60,92,109,130,143,152,177,197,208,213,231,236,253],"vendor-supplied":[6],"electronic":[7],"health":[8,100],"record":[9],"(EHR)":[10],"systems,":[11],"clinical":[12,76,165,203,243],"decision":[13],"support":[14,260,270],"(CDS)":[15],"customization":[16,230,252],"efforts":[17],"beyond":[18],"those":[19],"anticipated":[20],"by":[21],"vendor":[23],"may":[24,259],"require":[25],"use":[27],"technologies":[29],"external":[30],"to":[31,79,120,174,242,273],"EHR":[33,63,258],"such":[34,39],"as":[35],"web":[36,80],"services.":[37],"Pursuing":[38],"customizations,":[40],"however,":[41],"is":[42,64,271],"not":[43],"without":[44],"risk.":[45],"Validating":[46],"expected":[48],"behavior":[49],"a":[51,65,93,121,127,206,256],"customized":[52,122,199],"CDS":[53,84,123,134,154,161,200,237,254],"system":[54,124,181],"in":[55,87,132],"high-volume,":[57],"complex":[58,89,263],"environment":[59],"live":[62],"challenging":[66],"problem.":[67],"OBJECTIVE:":[68],"This":[69,246],"article":[70],"identifies":[71],"technology":[72],"failures":[73,171],"that":[74,163,250],"impacted":[75],"care":[77,103,261],"related":[78,119],"service-based":[81],"advanced":[82,251],"custom":[83],"systems":[85],"embedded":[86],"sociotechnical":[90],"context":[91],"production":[94],"EHR.":[95],"METHODS:":[96],"In":[97],"an":[98,107],"academic":[99],"system's":[101],"primary":[102],"network,":[104],"we":[105],"performed":[106,126],"inventory":[108],"incidents":[110,145],"between":[111],"January":[112],"1,":[113],"2008":[114],"and":[115,125,188,269],"December":[116],"31,":[117],"2016":[118],"targeted":[128],"review":[129],"changes":[131],"source":[135],"code.":[136],"Additional":[137],"feedback":[138],"on":[139,225],"root":[141],"cause":[142],"individual":[144,214],"was":[146],"obtained":[147],"through":[148],"interviews":[149],"with":[150,216],"members":[151],"project":[155],"teams.":[156],"RESULTS:":[157],"We":[158],"identified":[159],"five":[160],"malfunctions":[162,196],"impaired":[164,202],"workflow.":[166,244],"The":[167],"mechanisms":[168],"for":[169,205,233,262],"these":[170],"are":[172],"mapped":[173],"four":[175],"characteristics":[176],"well-behaved":[178],"applications:":[179],"(1)":[180],"integrity;":[182,185],"(2)":[183],"data":[184],"(3)":[186],"reliability;":[187],"(4)":[189],"scalability.":[190],"Over":[191],"9-year":[193],"period,":[194],"two":[195],"significantly":[201],"workflow":[204],"total":[207],"5":[209],"hours.":[210],"Lesser":[211],"impacts-loss":[212],"features":[215],"straightforward":[217],"workarounds-arose":[218],"from":[219],"three":[220],"malfunctions,":[221],"which":[222],"affected":[223],"users":[224],"53":[226],"days.":[227],"DISCUSSION:":[228],"Advanced":[229],"EHRs":[232],"purpose":[235],"can":[238],"present":[239],"significant":[240],"risks":[241],"CONCLUSION:":[245],"case":[247],"study":[248],"highlights":[249],"within":[255],"commercial":[257],"patient":[264],"populations,":[265],"but":[266],"ongoing":[267],"monitoring":[268],"required":[272],"ensure":[274],"its":[275],"safe":[276],"use.":[277]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":4},{"year":2024,"cited_by_count":2},{"year":2021,"cited_by_count":2},{"year":2020,"cited_by_count":2},{"year":2019,"cited_by_count":2}],"updated_date":"2026-06-27T08:28:00.272161","created_date":"2025-10-10T00:00:00"}
