| Abstract | Objective: To review the evidence from controlled trials of the effects of computer-based clinical decision
support systems (CDSSs) on clinician performance and patient outcomes.
Data Sources: The literature in the MEDLARS, EMBASE, SCISEARCH, and INSPEC databases was
searched from 1974 to the present. Conference proceedings and reference lists of relevant articles were
reviewed. Evaluators of CDSSs were asked to identify additional studies.
Study Selection: 793 citations were examined, and 28 controlled trials that met predefined criteria were
reviewed in detail.
Data Extraction: Study quality was assessed, and data on setting, clinicians and patients, method of
allocation, computer system, and outcomes were abstracted and verified using a structured form. Separate
summaries were prepared for physician and patient outcomes. Within each of these categories, studies were
classified further according to the primary purpose of the CDSS: drug dose determination, diagnosis, or
quality assurance.
Results: Three of 4 studies of computer-assisted dosing, 1 of 5 studies of computer-aided diagnosis, 4 of 6
studies of preventive care reminder systems, and 7 of 9 studies of computer-aided quality assurance for
active medical care that assessed clinician performance showed improvements in clinician performance using
a CDSS. Three of 10 studies that assessed patient outcomes reported significant improvements.
Conclusions: Strong evidence suggests that some CDSSs can improve physician performance. Additional
well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient
outcomes. |