title: The perils of meta-regression to identify clinical decision support system success factors.
abstract: Clinical decision support interventions are typically heterogeneous in nature, making it difficult to identify why some interventions succeed while others do not. One approach to identify factors important to the success of health information systems is the use of meta-regression techniques, in which potential explanatory factors are correlated with the outcome of interest. This approach, however, can result in misleading conclusions due to several issues. In this manuscript, we present a cautionary case study in the context of clinical decision support systems to illustrate the limitations of this type of analysis. We then discuss implications and recommendations for future work aimed at identifying success factors of medical informatics interventions. In particular, we identify the need for head-to-head trials in which the importance of system features is directly evaluated in a prospective manner.
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108, United States. Electronic address: chris.fillmore@imail.org.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Fillmore
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108, United States.
authors.forename: Casey A
authors.initials: CA
authors.lastname: Rommel
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108, United States.
authors.forename: Brandon M
authors.initials: BM
authors.lastname: Welch
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108, United States.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108, United States.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
mesh_terms: D000465:Algorithms; D001331:Automation; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D008490:Medical Informatics / Q000379:methods; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012984:Software; D014584:User-Computer Interface
keywords: Clinical decision support; Meta-regression