AHRQ Review of Clinical Decision Support

The Agency for Healthcare Research and Quality sponsors comprehensive research into various aspects of health and health care and a particularly useful series of these reports is the Evidence Report/Technology Assessment group.  AHRQ recently released a draft report on Enabling Health Care Decisionmaking through Clinical Decision Support and Knowledge Management.   (AHRQ Review) In the typical manner of these reports, the authors did an exhaustive literature search and then combined and summarized the results to come up with the current state of the evidence on the value of the technology being considered.

Clinical decision support systems aim to assist providers by making available information, hopefully at the point of care, that guides the provider to use of the most effective care for a patient.  The systems include alerts, reminders, computer-assisted diagnosis, order sets and guideline decision trees.  The researchers looked at both commercial and locally developed systems and found that both types of systems have good evidence for improving processes of care, but that minimal evidence exists for impacts on clinical outcomes or costs.

The research identified three previous factors correlated with CDS success:  automatic provision of the decision support as part of clinician workflow; provision at the time of decisionmaking; and provision of a recommendation, not just an assessment.  The authors also identified four new factors in success:  integration with a charting or order entry system; promotion of action as opposed to inaction; no need for additional clinician data entry; and local user involvement in the development of the system.  Given the explosion in medical knowledge and accompanying guidelines, clinical decision support systems should be a routine part of care, but research like that featured in this report is necessary to ensure that the systems actually are helpful and are used.