Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review

This article reviews controlled trials assessing the effects of computerized clinical decision support systems (CDSSs) and identifing study characteristics predicting benefit to patient care. We included randomized and nonrandomized controlled trials that evaluated the effect of a CDSS compared with care provided without a CDSS on practitioner performance or patient outcomes. One hundred studies met our inclusion criteria and CDSS improved practitioner performance in 62 of the 97 studies assessing this outcome. Improved practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system (success in 73% of trials vs 47%; P = .02) and studies in which the authors also developed the CDSS software compared with studies in which the authors were not the developers (74% success vs 28%; respectively, P = .001). In conclusion, many CDSSs improve practitioner performance; however, the effects on patient outcomes remain understudied and, when studied, inconsistent.