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This taxonomy provides a shared set of override domains that can be used by developers and researchers when analyzing why users do not accept patient-centered clinical decision support guidance.
Developed by the AHRQ Clinical Decision Support Innovation Collaborative's CDS Standards and Regulatory Frameworks Workgroup, this report provides a framework for analyzing patient-centered clinical decision support (PC CDS) overrides to support improvements in PC CDS to ensure that it is delivered at the right time, for the right patients and clinicians, and that it conveys clinically valuable and actionable information to inform shared decision making.
Recipients of patient-centered clinical decision support (PC CDS) alerts and recommendations—including patients, clinicians, or caregivers—may choose not to follow the recommendations or guidance for various reasons. Some clinical decision support (CDS) systems require recipients to identify a reason when they choose not to follow the guidance, called an “override reason.” To support CDS researchers and developers, this report offers a taxonomy of override reasons for PC CDS to better capture information on the barriers and challenges to PC CDS use, and to better understand what can be done to improve PC CDS, thereby promoting adoption and broader use.
About the Taxonomy
Based on real-world CDS implementations identified through a literature review and soliciting override reasons from CDS developers and health systems, the taxonomy provides a framework for analyzing PC CDS overrides. The taxonomy can be used by PC CDS developers, PC CDS researchers, health systems, electronic health record developers, and patient groups as they investigate why users of PC CDS tools dismiss PC CDS recommendations and alerts. Standardized analysis facilitated by the taxonomy domains can support the translation of results across clinical settings and PC CDS types. The taxonomy encompasses override reasons related to the following domains:
- The applicability of the PC CDS to the patient
- The context in which the PC CDS is delivered
- The evidence underlying the PC CDS
- Potential health outcomes
- Patient preferences and values
- Logistical and other barriers to completion of the actions recommended by the PC CDS
How To Use The Taxonomy
The taxonomy is meant to be used by PC CDS developers and researchers for analysis of reasons expressed by PC CDS recipients for not accepting PC CDS guidance. The taxonomy can be implemented by health systems to gauge why a given PC CDS alert is being frequently overridden, and point to ways in which the PC CDS can be improved. It can also be used by researchers to investigate override reasons. It is particularly suited to facilitating comparison of overrides of PC CDS across different institutions to share lessons learned.
Suggested Citation: Boxwala AA, Correa KH, Leaphart D, Richesson RL, Ahmed A, Desai PJ, Dullabh PM, and the CDSiC Standards and Regulatory Frameworks Workgroup. An Initial Taxonomy of Override Reasons for Patient-Centered Clinical Decision Support Recommendations. Prepared under Contract No. 75Q80120D00018. AHRQ Publication No. 24-0069-3. Rockville, MD: Agency for Healthcare Research and Quality; July 2024.
