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Malfunctions in distributed clinical decision support: 3 cases from a multi‑component clinical decision support
Jeritt G Thayer1,2,3, Gerald P Shaeffer2,3, Alexander G Fiks1,2,3
1Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19146, United States.
Summary
Distributed clinical decision support (CDS) systems can fail silently due to common issues like clock drift and data problems. Expanding the definition of CDS to include external partners is crucial for reliable healthcare delivery.
Area of Science:
- Health Informatics
- Computer Science
- Software Engineering
Background:
- Distributed clinical decision support (CDS) systems integrate electronic health records (EHRs) with external services.
- These architectures, while enabling interoperability, introduce novel failure modes impacting time-sensitive care.
- Real-world examples of such distributed CDS malfunctions are scarce.
Purpose of the Study:
- To describe specific malfunctions in a distributed CDS system.
- To highlight common distributed system failure modes in a clinical context.
- To inform best practices for distributed CDS implementation and monitoring.
Main Methods:
- Case report detailing three distinct malfunctions in a distributed CDS system.
- Analysis of failure modes including clock drift, data availability issues, and asynchronous processing.
- Focus on a system supporting smoking cessation referrals.
Main Results:
- Identified clock drift as a failure mode impacting CDS.
- Observed timing-related data availability problems in distributed systems.
- Documented issues with asynchronous processing between partner systems.
Conclusions:
- The definition of a CDS system should encompass external components and third-party partners.
- Monitoring distributed systems requires diverse methods to address varied failure potentials.
- Software architecture plays a critical role in the reliability of distributed CDS.
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