Medical exceptions to decision support: a tool to identify provider misconceptions and direct academic detailing

Clinical decision support can be used to capture the medical exceptions that justify deviations from guideline-based care. Peer review of this data is a potentially valuable and efficient means of identifying physician misconceptions or gaps in the medical knowledge base. Our early experience performing peer review on medical exceptions recorded through computerized point-of-care alerts shows that most medical exceptions were legitimate. Twelve percent of exceptions were inappropriate and 10% involved areas of considerable medical uncertainty.