Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research.
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.


METHODS
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.


METHODS
793 citations were examined, and 28 controlled trials that met predefined criteria were reviewed in detail.


METHODS
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.
Johnston
M E
ME
McMaster University, Hamilton, Ontario, Canada.
Langton
K B
KB
Haynes
R B
RB
Mathieu
A
A
D002983:Clinical Competence / Q000592:standards*; D003658:Decision Making, Computer-Assisted; D003936:Diagnosis, Computer-Assisted; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D017010:Reminder Systems