Improving Clinical Practice Using Clinical Decision Support Systems: A Systematic Review of Trials to Identify Features Critical to Success

This systematic review of randomized controlled trials seeks to identify features of clinical decision support systems critical for improving clinical practice.  Seventy studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature.  Decision support systems were found to significantly improve clinical practice in 68% of trials.  Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P < 0.00001), provision of recommendations rather than just assessments (P = 0.0187), provision of decision support at the time and location of decision making (P = 0.0263), and computer-based decision support (P = 0.0294). Of 32 systems possessing all four features, 30 (94%) significantly improved clinical practice. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these features whenever feasible and appropriate to improve patient care.