title: [Computerized decision support systems: EBM at the bedside].
abstract: One of the aims of Evidence-Based Medicine is to improve quality and appropriateness of care by the expedition of the knowledge transfer process. Computerized Decision Support Systems (CDSSs) are computer programs that provide alerts to the prescribing doctor directly at the moment of medical examination. In fact, alerts are integrated within the single patient electronic health record. CDSS based on the best available and updated evidence and guidelines may be an efficient tool to facilitate the transfer of the latest results from clinical research directly at the bedside, thus supporting decision-making.
  
  
  
  The CODES (COmputerized DEcision Support) trial is a research program funded by the Italian Ministry of Health and the Lombardy Region. It aims to evaluate the feasibility of the implementation of a CDSS at the hospital level and to assess its efficacy in daily clinical practice.
  
  
  
  The CODES project includes two pragmatic RCTs testing a CDSS (i.e. the EBMeDS - MediDSS) in two large Italian hospitals: the first is a general hospital in Vimercate (Lombardy), the second is an oncologic research center in Meldola (Emilia Romagna). The CDSS supports a full spectrum of decisions: therapy, drug interactions, diagnosis, and management of health care services are covered by a hundreds of reminders. However only few reminders are activated per patient, highlighting crucial problems in the delivery of high-quality care. The two trials have similar design and primary outcome, the rate at which alerts detected by the software are resolved by a decision of the clinicians. The project also includes the assessment of barriers and facilitators in the adoption of these new technologies by hospital staff members and the retrospective evaluation of the repeated risks in prescription habits.
  
  
  
  The trials are ongoing and currently more than 10,000 patients have been randomized. The qualitative analysis revealed a progressive shift in the perception of the tool. Doctors are now seeing it as a trusted second opinion, available 24/7, which is tailored to the needs of the patient. The retrospective analysis showed the opportunity to achieve a better healthcare quality through an active risk management. Aggregating data from whole hospitals emerge rare drug interactions that otherwise would not be recognizable.
  
  
  
  CDSS are promising tools to support clinicians in everyday practice. They can be used as a real time app or to perform retrospective analyses. These data can provide unique resources to hospital management.
authors.affiliation: Scuola di Specializzazione in Igiene e Medicina Preventiva, Università di Milano.
authors.forename: Matteo
authors.initials: M
authors.lastname: Capobussi
authors.affiliation: IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano.
authors.forename: Rita
authors.initials: R
authors.lastname: Banzi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università di Milano.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.affiliation: Humanitas Clinical and Research Center, Milano.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bonovas
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università di Milano - Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milano.
authors.forename: Marien
authors.initials: M
authors.lastname: González-Lorenzo
authors.affiliation: Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge.
authors.forename: Elisa Giulia
authors.initials: EG
authors.lastname: Liberati
authors.affiliation: Dipartimento di Medicina Interna, ASST di Vimercate (MB).
authors.forename: Hernan
authors.initials: H
authors.lastname: Polo Friz
authors.affiliation: IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola (FC).
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
authors.affiliation: Medilogy Srl, Milano.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mangia
authors.affiliation: Unità di Epidemiologia Clinica, IRCCS Istituto Ortopedico Galeazzi, Milano.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ruggiero
mesh_terms: D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D019317:Evidence-Based Medicine; D006801:Humans; D007558:Italy; D012189:Retrospective Studies