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Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research

Mary E. Johnston, BSc; Karl B. Langton, MSc; R. Brian Haynes, MD, PhD; and Alix Mathieu, MD
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From McMaster University, Hamilton, Ontario, Canada; University of Cincinnati, Cincinnati, Ohio. Requests for Reprints: R. Brian Haynes, MD, PhD, McMaster University Health Sciences Centre, Room 3H7, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. Acknowledgments: The authors thank C. Walker Dilks and T. Fleming for help with literature searching, J. Wyatt for his comments, and authors for responding to our requests for additional information. Grant Support: Supported by the Brian C. Decker Health Information Research Fund and the Medical Research Council of Canada. Dr. Haynes is supported by a National Health Scientist Award from the National Health Research and Development Programme of Health and Welfare Canada.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(2):135-142. doi:10.7326/0003-4819-120-2-199401150-00007
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Objective: To review the evidence from controlled trials of the effects of computer-based clinical decision support systems (CDSSs) on clinician performance and patient outcomes.

Data Sources: The literature in the MEDLARS, EMBASE, SCISEARCH, and INSPEC databases was searched from 1974 to the present. Conference proceedings and reference lists of relevant articles were reviewed. Evaluators of CDSSs were asked to identify additional studies.

Study Selection: 793 citations were examined, and 28 controlled trials that met predefined criteria were reviewed in detail.

Data Extraction: Study quality was assessed, and data on setting, clinicians and patients, method of allocation, computer system, and outcomes were abstracted and verified using a structured form. Separate summaries were prepared for physician and patient outcomes. Within each of these categories, studies were classified further according to the primary purpose of the CDSS: drug dose determination, diagnosis, or quality assurance.

Results: Three of 4 studies of computer-assisted dosing, 1 of 5 studies of computer-aided diagnosis, 4 of 6 studies of preventive care reminder systems, and 7 of 9 studies of computer-aided quality assurance for active medical care that assessed clinician performance showed improvements in clinician performance using a CDSS. Three of 10 studies that assessed patient outcomes reported significant improvements.

Conclusions: Strong evidence suggests that some CDSSs can improve physician performance. Additional well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient outcomes.





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