title: Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review.
abstract: BACKGROUND
  Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners.
  
  
  METHODS
  We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes.
  
  
  RESULTS
  Thirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002). Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33) of CCDSSs improved testing behavior overall, including 83% (5/6) for diagnosis, 63% (5/8) for treatment monitoring, 35% (6/17) for disease monitoring, and 100% (3/3) for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported.
  
  
  CONCLUSIONS
  Some CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such as system design, user interface, local context, implementation strategy, and evaluate impact on user satisfaction and workflow, costs, and unintended consequences.
authors.affiliation: Health Research Methodology Program, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
authors.forename: Pavel S
authors.initials: PS
authors.lastname: Roshanov
authors.forename: John J
authors.initials: JJ
authors.lastname: You
authors.forename: Jasmine
authors.initials: J
authors.lastname: Dhaliwal
authors.forename: David
authors.initials: D
authors.lastname: Koff
authors.forename: Jean A
authors.initials: JA
authors.lastname: Mackay
authors.forename: Lorraine
authors.initials: L
authors.lastname: Weise-Kelly
authors.forename: Tamara
authors.initials: T
authors.lastname: Navarro
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilczynski
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
mesh_terms: D003258:Consumer Behavior; D003299:Cooperative Behavior; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000706:statistics & numerical data*; D014943:Global Health; D006801:Humans; D008991:Monitoring, Physiologic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States