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Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review

Authors

Garg, A. X., Adhikari, N. K., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., Haynes, R. B.

Journal

JAMA

Publication Date

2005 Mar 9

Volume

293

Issue

Pages

1223-38

HIT Description: Decision support More info...
Purpose of Study: To review controlled trials assessing the effects of computerized clinical decision support systems and to identify study characteristics predicting benefit.
Years of study: Studies published through September 2004
Study Design: Systematic review. 100 studies were included.
Outcomes: Varied across studies.

Summary:

Settings: Approximately two thirds of studies came from the United States, followed by smaller numbers from the United Kingdom, Canada, and Australia. Developers of the software were study authors in 72% of trials. 76 took place in academic centers. 33% were inpatient-based.
Intervention: Varied across studies.
Evaluation Method: Varied across studies.
Description: In 47% of studies the computerized decision support system was part of an electronic medical record or computer order entry system. Most of these were early generation systems lacking the full functionality of current systems.
Quality of Care and Patient Safety Outcome: The authors described their results in the following categories: systems for diagnosis were evaluated in ten trials and four of these reported beneficial effects; reminder systems for prevention were the focus of 21 trials, and of these 16 reported beneficial results; 40 studies assessed systems for disease management, and of these 62% reported improved practitioner performance and 18% demonstrated improved patient outcomes; 29 trials assessed systems for drug dosing and prescribing with 62% of single drug dosing studies reporting improved practitioner performance and 2 of 18 systems reporting improvements in patient outcomes. 4 of the 5 systems assessing multi drug prescribing reported improved practitioner performance but none reported improved patient outcomes. Among study factors associated with success, the authors reported that studies in which users were automatically prompted to use the system described better performance compared with studies in which users had to actively initiate the system (73% su

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