2026/06/16 by Jeritt G. Thayer, Gerald Shaeffer, A Fiks +6 · 1 voice
Medicine · Health Professions · Computer Science · #Healthcare Technology and Patient Monitoring #Electronic Health Records Systems #Distributed systems and fault tolerance
paper · doi:10.1093/jamia/ocag114
openalex publication_date 2026/06/16 · openalex created_date 2026/06/27 · openalex updated_date 2026/06/27
INTRODUCTION: Clinical decision support (CDS) is increasingly delivered through distributed architectures that connect electronic health record (EHR) workflows to external services and community partners. While these designs enable rapid deployment and interoperability, they also introduce new failure modes that can silently disrupt time‑sensitive care processes. Practical, real‑world descriptions of these distributed CDS malfunctions remain limited. CASE REPORT: We describe 3 malfunctions in a distributed CDS system used to support smoking cessation referrals. The issues reflected common distributed‑system failure modes, including clock drift, timing‑related data availability problems, and asynchronous processing across partner systems. CONCLUSION AND RECOMMENDATIONS: Given the implications software architecture can have on distributed systems, it is critical to expand the definition of what constitutes the CDS system to include components outside the EHR, including those of third-party partners system. Further, monitoring techniques for distributed systems may also require multiple methods to account for differences in how each component can fail.