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Computer-based guideline implementation systems: a systematic review of functionality and effectiveness.

R N Shiffman1, Y Liaw, C A Brandt

  • 1Center for Medical Informatics, Yale School of Medicine, New Haven, CT 06520-8009, USA. richard.shiffman@yale.edu

Journal of the American Medical Informatics Association : JAMIA
|March 27, 1999
PubMed
Summary
This summary is machine-generated.

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Computer-based guideline systems offer patient-specific recommendations and improve clinician adherence. These systems enhance documentation, but communication services are most effective when integrated with electronic medical records.

Area of Science:

  • Medical Informatics
  • Clinical Decision Support Systems

Background:

  • Effective implementation of clinical guidelines is crucial for improving healthcare quality.
  • Computer-based systems offer potential solutions for guideline dissemination and adherence.

Purpose of the Study:

  • To systematically review computer-based guideline implementation systems.
  • To analyze system functionality and characterize their effectiveness.

Main Methods:

  • Systematic review of 25 studies (1992-1998) evaluating computer-based guideline implementation systems.
  • Inclusion criteria: intent to implement guidelines and evaluated effectiveness.
  • Data extraction on information management services and impact on adherence, documentation, satisfaction, and patient outcomes.

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Main Results:

  • All systems provided patient-specific recommendations; 19 offered them concurrently with care.
  • Explanation services were available in 9 systems; interactive documentation in 9; paper output in 17.
  • Guideline adherence improved in 14/18 systems; documentation improved in 4/4.
  • Communication services were most common in systems integrated with electronic medical records.

Conclusions:

  • Computer-based guideline implementation systems show promise in improving guideline adherence and documentation.
  • System functionality varies, with patient-specific recommendations and concurrent care availability being common.
  • Integration with electronic medical records appears beneficial for communication services.