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Effect of clinical decision-support systems: a systematic review
Tiffani J Bright1, Anthony Wong, Ravi Dhurjati
1Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Annals of Internal Medicine
|July 4, 2012
Summary
Clinical decision-support systems (CDSSs) effectively improve healthcare processes like preventive services and prescribing. However, robust evidence for clinical and economic benefits remains limited, despite their proven utility across various settings.
Area of Science:
- Health Informatics
- Clinical Decision Support Systems
- Evidence-Based Medicine
Background:
- Limited evidence exists to support the widespread adoption of clinical decision-support systems (CDSSs) despite their potential for improving care and reducing costs.
- The Agency for Healthcare Research and Quality funded this research.
Purpose of the Study:
- To evaluate the impact of CDSSs on clinical outcomes, healthcare processes, provider workload and efficiency, patient satisfaction, costs, and implementation.
- To synthesize evidence from randomized controlled trials on the effectiveness of electronic CDSSs.
Main Methods:
- A systematic review of randomized controlled trials was conducted using MEDLINE, CINAHL, PsycINFO, and Web of Science databases up to January 2011.
- Studies included electronic CDSSs used by healthcare providers at the point of care, reporting on various outcomes.
- Data extraction focused on study design, participant characteristics, interventions, outcomes, and quality.
Main Results:
- 148 randomized controlled trials were analyzed, with 86% assessing healthcare process measures, 20% clinical outcomes, and 15% costs.
- CDSSs, both commercial and locally developed, demonstrated significant improvements in healthcare process measures, including preventive services, diagnostic test ordering, and therapy prescribing.
- Few studies reported on unintended consequences or adverse effects of CDSS implementation.
Conclusions:
- CDSSs are effective in enhancing healthcare process measures across diverse clinical settings, including outside of academic centers.
- Evidence supporting the impact of CDSSs on clinical outcomes, economic factors, workload, and efficiency is still sparse.
- Heterogeneity in study interventions, populations, settings, and outcomes, along with potential publication bias, limits definitive conclusions.
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