Clinical decision support capabilities of commercially-available clinical information systems.
BACKGROUND
The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems.


METHODS
The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features.


RESULTS
Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern.


CONCLUSIONS
These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.
Wright
Adam
A
Partners HealthCare System, 93 Worcester St, Wellesley, MA 02481, USA. awright5@partners.org
Sittig
Dean F
DF
Ash
Joan S
JS
Sharma
Sapna
S
Pang
Justine E
JE
Middleton
Blackford
B
D020000:Decision Support Systems, Clinical; D006801:Humans; D012985:Software Design; D013673:Technology Assessment, Biomedical; D014481:United States