title: Effect of clinical decision-support systems: a systematic review.
abstract: BACKGROUND
  Despite increasing emphasis on the role of clinical decision-support systems (CDSSs) for improving care and reducing costs, evidence to support widespread use is lacking.
  
  
  OBJECTIVE
  To evaluate the effect of CDSSs on clinical outcomes, health care processes, workload and efficiency, patient satisfaction, cost, and provider use and implementation.
  
  
  METHODS
  MEDLINE, CINAHL, PsycINFO, and Web of Science through January 2011.
  
  
  METHODS
  Investigators independently screened reports to identify randomized trials published in English of electronic CDSSs that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, health care process, workload, relationship-centered, economic, or provider use outcomes.
  
  
  METHODS
  Investigators extracted data about study design, participant characteristics, interventions, outcomes, and quality.
  
  
  RESULTS
  148 randomized, controlled trials were included. A total of 128 (86%) assessed health care process measures, 29 (20%) assessed clinical outcomes, and 22 (15%) measured costs. Both commercially and locally developed CDSSs improved health care process measures related to performing preventive services (n= 25; odds ratio [OR], 1.42 [95% CI, 1.27 to 1.58]), ordering clinical studies (n= 20; OR, 1.72 [CI, 1.47 to 2.00]), and prescribing therapies (n= 46; OR, 1.57 [CI, 1.35 to 1.82]). Few studies measured potential unintended consequences or adverse effects.
  
  
  CONCLUSIONS
  Studies were heterogeneous in interventions, populations, settings, and outcomes. Publication bias and selective reporting cannot be excluded.
  
  
  CONCLUSIONS
  Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse. This review expands knowledge in the field by demonstrating the benefits of CDSSs outside of experienced academic centers.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors: Duke Evidence-based Practice Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
authors: Tiffani J
authors: TJ
authors: Bright
authors: Anthony
authors: A
authors: Wong
authors: Ravi
authors: R
authors: Dhurjati
authors: Erin
authors: E
authors: Bristow
authors: Lori
authors: L
authors: Bastian
authors: Remy R
authors: RR
authors: Coeytaux
authors: Gregory
authors: G
authors: Samsa
authors: Vic
authors: V
authors: Hasselblad
authors: John W
authors: JW
authors: Williams
authors: Michael D
authors: MD
authors: Musty
authors: Liz
authors: L
authors: Wing
authors: Amy S
authors: AS
authors: Kendrick
authors: Gillian D
authors: GD
authors: Sanders
authors: David
authors: D
authors: Lobach
mesh_terms: D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics / Q000592:standards*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome