title: Evidence-based clinical decision support.
abstract: BACKGROUND
  Clinical decision support (CDS) is a key tool for enabling evidence-based medicine and improving the quality of healthcare. However, effective CDS faces a variety of challenges, including those relating to knowledge synthesis, capture, transformation, localization and maintenance. If not properly addressed, these challenges can limit the effectiveness of CDS, and potentially risk inaccurate or inappropriate interventions to clinicians.
  
  
  OBJECTIVE
  (1) To describe an approach to CDS development using evidence as a basis for clinical decision support systems that promote effective care; (2) To review recent evidence regarding the effectiveness of selected clinical decision support systems.
  
  
  METHODS
  Review and analysis of recent literature with identification of trends and best practices.
  
  
  RESULTS
  The state-of-the-art in CDS has advanced significantly, and many recent trials have shown CDS to be effective, although the results are mixed overall. Issues related to knowledge capture and synthesis, problems in knowledge transformation at the interface between knowledge authors and CDS developers, and problems specific to local CDS design and implementation can interfere with CDS development. Best practices, tools and techniques to manage them are described.
  
  
  CONCLUSIONS
  CDS, when used well, can be effective, but further research is needed for it to reach its full potential.
authors: Yale Center for Medical Informatics, 300 George St., Ste 501, New Haven, CT 06511 USA. E-mail: richard.shiffman@yale.edu.
authors: R N
authors: RN
authors: Shiffman
authors: A
authors: A
authors: Wright
mesh_terms: D020000:Decision Support Systems, Clinical; D006801:Humans