title: Using electronic health record clinical decision support is associated with improved quality of care.
abstract: OBJECTIVE
  To determine whether clinical decision support (CDS) is associated with improved quality indicators and whether disabling CDS negatively affects these.
  
  
  METHODS
  Using the 2006-2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys, we performed logistic regression to analyze adult primary care visits for the association between the use of CDS (problem lists, preventive care reminders, lab results, lab range notifications, and drug-drug interaction warnings) and quality measures (blood pressure control, cancer screening, health education, influenza vaccination, and visits related to adverse drug events).
  
  
  RESULTS
  There were an estimated 900 million outpatient primary care visits to clinics with EHRs from 2006-2009; 97% involved CDS, 77% were missing at least 1 CDS, and 15% had at least 1 CDS disabled. The presence of CDS was associated with improved blood pressure control (86% vs 82%; OR 1.3; 95% CI, 1.1-1.5) and more visits not related to adverse drug events (99.9% vs 99.8%; OR 3.0; 95% CI, 1.3-7.3); these associations were also present when comparing practices with CDS against practices that had disabled CDS. Electronic problem lists were associated with increased odds of having a visit with controlled blood pressure (86% vs 80%; OR 1.4; 95% CI, 1.3-1.6). Lab result notification was associated with increased odds of ordering cancer screening (15% vs 10%; OR 1.5; 95% CI, 1.03-2.2).
  
  
  CONCLUSIONS
  The use of CDS was associated with improvement in some quality indicators. Not having at least 1 CDS was common; disabling CDS was infrequent. This suggests that meaningful use standards may improve national quality indicators and health outcomes, once fully implemented.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, BC-3-2X, Boston, MA 02120. E-mail: rmishuris@partners.org.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Mishuris
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
mesh_terms: D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology