Computerized clinical decision support systems (CDSS) are electronic tools that prompt provider behaviors in various areas of patient care, including medication ordering, chronic disease management, health care screening, and vaccination. CDSS can provide physicians, nurses, pharmacists, and other care providers with patient-specific prompts or warnings, treatment guidelines (e.g., order sets), automatic medication dosing calculators, or reports of overdue tests and medications as appropriate. These tools can be integrated with comprehensive electronic health record (EHR) systems, part of a computerized physician order entry (CPOE) system, or a standalone electronic interface; various types of CDSS exist for different workflows and settings, including primary, inpatient, acute, long term, and dental care.
Expected Beneficial Outcomes (Rated)
Improved processes of care
Other Potential Beneficial Outcomes
Increased appropriate drug prescribing
Improved health outcomes
Improved patient safety
Evidence of Effectiveness
There is strong evidence that computerized clinical decision support systems (CDSS) improve processes of care1, 2, 3, 4, 5, 6, 7, 8, 9, 10, particularly when used for drug prescribing and management3, 8, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24. Such systems have also been shown to improve patient outcomes in some circumstances1, 2, 7, 8, 9, 13, 19, 20, 25, 26, 27, 28. Additional evidence is needed to confirm effects on patient outcomes.
CDSS can improve processes of care in primary care10, long term care3, and acute care settings8, 29, especially when systems support preventive services, prescribing therapies, and ordering of clinical studies5 and tests7. CDSS can also improve processes for chronic disease management6 and preventive care, such as screening and management of asthma30, high cholesterol9, and cardiovascular disease4. In some circumstances, such systems can improve processes related to cancer screening and referrals, and mental health conditions9.
Clinical decision support systems can increase compliance with recommendations, guidelines, and protocols in medication prescription11, 12, 26, 31, transplant care1, and laboratory test ordering32, 33, and decrease inappropriate testing34, 35, 36. CDSS may also benefit high risk groups, for example, decreasing inappropriate opioid prescribing among veterans31 and increasing safety planning for youth at risk of suicide37.
CDSS can improve medication management1, 17, prescribing outcomes22, and increase medication safety3, 13. Combined with computerized provider order entry (CPOE), clinical decision support systems reduce medication prescribing errors14, 16, 23 and may also reduce adverse drug events16, 24. Medication dosing advice via CDSS can improve some patient outcomes8, 15 and increase physician compliance with guidelines20, 21, 38. Pharmacy-specific CDSS that address potential safety concerns are more effective than CDSS that promote compliance with evidence-based guidelines39.
Frequent CDSS alerts, especially inappropriate alerts, lead to “alert fatigue” and may cause users to miss or ignore important alerts16, 30, 40. These point of care reminders are more likely to improve clinical processes of care when providers are required to enter a response41. Clinical decision support systems can be less effective when doctors do not follow system advice12.
Clinical decision support systems have been shown to improve patient outcomes in some circumstances1, 6, 8, 9, 20, 25, 27. CDSS appear most likely to improve patient outcomes when used to help manage chronic conditions27 such as high cholesterol9 and diabetes2, 19. Such systems can improve blood glucose when implemented as part of a complex hospital-based intervention42. CDSS may also reduce adverse events25, 26 and mortality in inpatient care25.
Researchers suggest standardized content that can be easily updated and integration in an EHR to provide timely and appropriate support during workflows will increase the ability of CDSS to support diagnosis43. The frequent need for customization on a site-by-site basis to meet organizational, departmental, and provider needs and practices, and lack of interoperability between different EHRs can be barriers to CDSS implementation44. Recommendations for implementing CDSS and other e-health technologies include considering their complexity, adaptability, and compatibility with existing systems when selecting a system and involving key stakeholders early in the implementation process45.
Impact on Disparities
Many commercially produced EHRs include CDSS48, and organizations such as Brigham and Women’s Hospital and the Yale School of Medicine developed decision support systems as part of the AHRQ Clinical Decision Support Demonstration Projects44.
Partners Healthcare System, an integrated system of hospitals in Massachusetts, uses CDSS to provide real-time reminders on guideline-based care recommendations for acute respiratory infections, CAD, and diabetes49.
US DHHS-Meaningful use - US Department of Health and Human Services (US DHHS). Achieve meaningful use.
AHRQ-CDS - Agency for Healthcare Research and Quality (AHRQ). Health information technology: Clinical decision support (CDS).
CDC DHDSP-CDSS - Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention (DHDSP). Implementing clinical decision support systems (CDSS).
ONCHIT-Implementing HIT - The Office of the National Coordinator for Health Information Technology (ONCHIT). Implementing Health IT.
NAM-Optimizing CDS - Optimizing strategies for clinical decision support: Summary of a meeting series. Tcheng JE, Bakken S, Bates DW, et al., ed. Washington, DC: National Academy of Medicine. 2017.
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48 ONCHIT-CDS - The Office of the National Coordinator for Health Information Technology (ONCHIT). Clinical decision support (CDS).
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