Computer decision support systems for asthma: a systematic review.
BACKGROUND
Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations.


OBJECTIVE
To synthesise the evidence for the use of CDSSs by professionals managing people with asthma.


METHODS
We systematically searched Medline, Embase, Health Technology Assessment, Cochrane and Inspec databases (1990 to April 2012, no language restrictions) for trials, and four online repositories for unpublished studies. We also wrote to authors. Eligible studies were randomised controlled trials of CDSSs supporting professional management of asthma. Studies were appraised (Cochrane Risk of Bias Tool) and findings synthesised narratively.


RESULTS
A total of 5787 articles were screened, and eight trials were found eligible, with six at high risk of bias. Overall, CDSSs for professionals were ineffective. Usage of the systems was generally low: in the only trial at low risk of bias the CDSS was not used at all. When a CDSS was used, compliance with the advice offered was also low. However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes. The study at moderate risk of bias showed increased prescribing of inhaled steroids.


CONCLUSIONS
The current generation of CDSSs is unlikely to result in improvements in outcomes for patients with asthma because they are rarely used and the advice is not followed. Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation.
Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
Patricia
P
Matui
Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK.
Jeremy C
JC
Wyatt
Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
Hilary
H
Pinnock
Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
Aziz
A
Sheikh
Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
Susannah
S
McLean
D001249:Asthma / Q000628:therapy*; D002986:Clinical Trials as Topic; D020000:Decision Support Systems, Clinical; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D016896:Treatment Outcome