title: Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review.
abstract: BACKGROUND
  Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit.
  
  
  METHODS
  We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.
  
  
  RESULTS
  Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements.
  
  
  CONCLUSIONS
  CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.
authors.affiliation: Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hemens
authors.forename: Anne
authors.initials: A
authors.lastname: Holbrook
authors.forename: Marita
authors.initials: M
authors.lastname: Tonkin
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: D000465:Algorithms; D035843:Biomedical Research; D003258:Consumer Behavior; D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine / Q000295:instrumentation* / Q000379:methods; D014943:Global Health; D006801:Humans; D008991:Monitoring, Physiologic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D014481:United States; D014584:User-Computer Interface
chemical_list: D055553:Prescription Drugs