Annals of Internal Medicine – Review of Clinical Decision Support Systems

Clinical Decision Support Systems (or CDSSs) are increasingly available through Electronic Health Records and include reminders, alerts, drug interaction checking and dose calculation systems as well as chronic disease reporting dashboards. Despite the pervasiveness of CDSSs, there is limited evidence regarding the ability of these systems to improve care and reduce costs.

A systematic review of 148 randomized controlled trials by Bright et al was published in the April 24, 2012 in the Annals of Internal Medicine. The article titled “Effect of Clinical Decision-Support Systems – A Systematic Review” examined three specific areas, health care process measures, clinical outcomes and costs.

Multiple meta-analyses were undertaken of groups of similar studies, however the heterogeneity of these studies limited general observations about CDSSs. The study authors were able to minimize limitations in their meta-analyses by including studies that assessed the same outcome in the same manner. Analysis did not offer sufficient sensitivity to draw conclusions with respect to CDSS implementation, effect on workflow, and factors affecting usability.

According to the authors, the systematic review ‘was able to demonstrate the efficacy of CDSSs on health care process outcomes across diverse settings for both commercially and locally developed systems, but data showing an effect on clinical and economic outcomes were sparse.’

The authors recommended further study and analysis to better understand how to effectively integrate clinical decision support tools in order to develop a better understanding of ‘what the right information is and when and how it should be delivered to the right person.’ They also recommend further analysis to identify the ‘unintended consequences of CDSS implementation.’

Have you had experience using CDSSs? Share the pros and cons of CDSSs tools you have used.


2 responses to "Annals of Internal Medicine – Review of Clinical Decision Support Systems"
  • May 16, 2012
    Michael S. Barr, MD, MBA, FACP

    HIMSS has a number of resources pertaining to CDSS here.

  • July 10, 2012
    Joey Albertson

    This review on clinical decisions support system featured in annals of internal medicine is amazing. I think CDSS needs further study for its future developments and somehow reduces its unintended consequences.

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