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Efficacy and Unintended Consequences of Hard-stop Alerts in Electronic Health Record Systems: a Systematic Review

This on-demand webinar does not offer CE credit.

Article Lead author Emily Powers will discuss this month's JAMIA Journal Club selection:

Powers E, Shiffman R, Melnick E, Hickner A, Sharifi M. Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review. J Am Med Inform Assoc. 2018 Sept 18; 25(11):1556-1566. doi: 10.1093/jamia/ocy112.

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Emily Powers, MD
Clincal Fellow
Yale Pediatric Emergency Medicine


Maryam Zolnoori, PhD
Columbia School of Nursing
Mayo Clinic


Mustafa Ibraheem Hussain
PhD Candidate
University of California, Irvine

Statement of Purpose

Clinical Decision Support in the form of alerts has increased exponentially in the era of meaningful use. An alert is now generated for 6-8% of all clinician-entered orders. These alerts have the capacity to provide useful information to clinicians at the point of care but their utility may be attenuated by unintended consequences such as alert fatigue or undesirable workarounds. Efforts at minimizing alert fatigue have included tiering alerts by importance and titrating the degree of interaction required by the clinician accordingly. Three different alert categories have arisen from these efforts: hard stops, soft stops, and passive alerts. We have sought with this systematic review to standardize the definition of these three types of alerts and then to ask three key questions of hard-stop alerts to better understand their appropriate application: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?

Target Audience

The target audience for this activity is professionals and students interested in biomedical and health informatics.

Learning Objectives

The general learning objective for all of the JAMIA Journal Club webinars is that participants will

  • Use a critical appraisal process to assess article validity and to gauge article findings' relevance to practice

After this live activity, the participant should be better able to:

  • Define the three alert categories: Hard Stop, Soft Stop, and Passive Alerts
  • Explain the extent to which hard-stop alerts are effective in improving patient health and healthcare delivery outcomes.
  • Identify adverse events and unintended consequences of hard-stop alerts.
  • Compare hard-stop alerts to soft-stop alerts.

This JAMIA Journal Club does not offer continuing education credit.

In our dedication to providing unbiased education even when no CE credit is associated with it, we provide planners’ and presenters’ disclosure of relevant financial relationships with commercial interests that has the potential to introduce bias in the presentation: 

Disclosures for this Activity

These faculty, planners, and staff who are in a position to control the content of this activity disclose that they and their life partners have no relevant financial relationships with commercial interests: 

JAMIA Journal Club presenter: Emily Powers
JAMIA Journal Club planners: Michael Chiang, Mustafa Ibraheem Hussain, Maryam Zolnoori
AMIA staff: Susanne Arnold, Pesha Rubinstein


Dates and Times: -
Type: Webinar
Course Format(s): On Demand