Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review
Journal
JAMA
Publication Date
2005 Mar 9
Volume
293
Issue
10
Pages
1223-38
Summary:
- HIT Description: Decision support More info...
- Purpose of Study: To review controlled trials assessing the effects of computerized clinical decision support systems (CDSS) and to identify study characteristics predicting benefit
- Years of study: 1973-2004
- Study Design: Systematic review
- Outcomes: Impact on health care effectiveness and quality
- Settings: Varies
- Intervention: Included studies that evaluated impact of CDSS vs. no CDSS on practitioner performance or patient outcomes.
- Evaluation Method: study abstraction of all reported practitioner performance and patient outcomes.
- Description: Any system where characteristics of individual patients are matched to a computerized database and software algorithms generate patient specific recommendations. These recommendations are delivered to the clinicians through electronic medical records, pager, or through printouts.
- Interoperability: In 47% of studies, the CDSS was part of an electronic health record (EHR) system or Computerized Provider Order Entry (CPOE) system.
- Strategy: Varies by study
- System Penetration: Varies by study
- Facilitators: Studies in which users were automatically prompted to use the system had better performance compared to studies where users had to actively initiate the system. Studies in which the authors also created the computer system reported better performance than those that used a system created elsewhere
- Healthcare Utilization: Trials testing CDSS to reduce unnecessary utilization measured the frequency of redundant testing, unnecessary hospital admissions, and length of stay; 3 of 4 trials reported improvements.
- Quality of Care and Patient Safety Outcome: There were 21 trials on reminder systems for prevention. All trials measured provider performance; CDSS was beneficial in 16 studies. Of 37 studies evaluating provider performance with disease management systems, 62% reported significant improvement. The few studies that measured patient outcomes showed mixed results.