{"id":44561,"date":"2019-05-07T15:28:14","date_gmt":"2019-05-07T14:28:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44561"},"modified":"2019-05-14T10:39:32","modified_gmt":"2019-05-14T09:39:32","slug":"kieran-walsh-what-happens-when-the-robot-makes-a-mistake","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/07\/kieran-walsh-what-happens-when-the-robot-makes-a-mistake\/","title":{"rendered":"Kieran Walsh: What happens when the robot makes a mistake? \u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Clinical decision support resources can reduce the risk of medical error. As a result, we encourage doctors and other healthcare professionals to use clinical decision support (CDS) when making decisions. But like anything else clinical decision support resources can sometimes get things wrong. What happens then? Do doctors notice that the clinical decision support system has made an error and over-ride it. Or do they blindly follow it and make an error themselves? \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Lyell et al have done a clever study to find out the answer to this question. [1] Their research was based around the concept of automation bias. This bias occurs when \u201cusers over-rely on CDS\u201d and so become less vigilant in looking for errors themselves that the clinical decision support system might have missed. Errors can be those of omission or commission (a bit like the Catholic sins). An omission error is when you don\u2019t notice an error because the clinical decision support system didn\u2019t tell you that there is an error. A commission error is when you follow recommendations that are not correct. They found that users of a clinical decision support system made both types of error. Their study was conducted with medical students in a simulation setting. It is hard to tell if you would get the same result with qualified doctors in a real-world setting. However, the simulation did mimic the real world quite closely\u2014they made some tasks more complex than others and staged interruptions to the user\u2019s workflow\u2014just as happens in real life.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is an important study. There is a lot of research into the effectiveness of robots and whether or not they may be better than humans at certain tasks. There is also a lot of research into how to make humans better and safer clinicians. However, there is not as much research on the interface between robots and humans and how one might affect the other. This study adds a piece to the jigsaw, but it also begs further questions. The most important one is what can we do to make sure that doctors do not follow clinical decision support systems down blind alleys.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Thus far our efforts have focused on telling clinicians that they should be vigilant and check things and don\u2019t rely too much on clinical decision support. The problem with this approach is that there is little evidence that it works. Clinicians might also understandably complain that they are receiving mixed messages\u2014on the one hand that clinical decision support will help them a great deal and on the other that they cannot rely on it completely. Maybe we need to be careful not to commit sins of omission when telling clinicians about the effectiveness of clinical decision support systems. \u00a0<\/span><\/p>\n<p><em><strong>Kieran Walsh<\/strong>\u00a0is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor\u2014specialising in care of the elderly medicine and neurology.\u00a0<\/em><\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400\"> Lyell D, Magrabi F, Raban MZ, Pont LG, Baysari MT, Day RO, Coiera E. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28302112\"><span style=\"font-weight: 400\">Automation\u00a0bias\u00a0in\u00a0electronic prescribing.<\/span><\/a><span style=\"font-weight: 400\"> BMC Med Inform Decis Mak. 2017 Mar 16;17(1):28.<\/span><\/li>\n<\/ol>\n<p><b>Competing interests:<\/b><\/p>\n<p><span style=\"font-weight: 400\">Kieran Walsh works for <em>The BMJ<\/em>\u2014which provides the clinical decision support tool BMJ Best Practice. <\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Clinical decision support resources can reduce the risk of medical error. As a result, we encourage doctors and other healthcare professionals to use clinical decision support (CDS) when making decisions. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/07\/kieran-walsh-what-happens-when-the-robot-makes-a-mistake\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":43586,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5732],"tags":[],"class_list":["post-44561","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-kieran-walsh"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Kieran Walsh: What happens when the robot makes a mistake? \u00a0 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/07\/kieran-walsh-what-happens-when-the-robot-makes-a-mistake\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Kieran Walsh: What happens when the robot makes a mistake? \u00a0 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Clinical decision support resources can reduce the risk of medical error. 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