Clinical decision support systems are designed to help physicians and other providers make good decisions about the care and treatment needs for individual patients. It is not an easy task to design them in a way that ensures the provision of credible, useful information at the point of care; and that avoids interfering with work flow. These systems have proliferated in recent years, but it is not clear that they have really helped improve quality, much less save money on a net basis. A new study in the Annals of Internal Medicine reviews applicable research to see what has been proven in regard to the use of clinical decision support systems. (Annals Article) The researchers identified three primary types of CDS: one is alerts, reminders and similar functions that prompt a physician to take certain actions; a second is information retrieval tools, which allow quick access to relevant data on a patient, coupled with pertinent general information; and the last is knowledge retrieval tools which summarize relevant findings such as clinical guidelines, drug summaries, etc. The researchers found about 150 relevant randomized trials.
A large number of these looked at adherence to care process measures; a much smaller number assessed actual health and cost outcomes. Many of the studies were conducted in institutions with a well-established health information technology culture, which is not representative of the typical US provider environment. There was modest evidence supporting a positive effect on morbidity, although the trials typically dealt with only one condition. There was basically no evidence to indicate an effect on mortality. Similarly, there was little evidence to support an effect on adverse events. In regard to health care processes, there was strong evidence of a positive effect on ensuring delivery of recommended preventative care and also for the ordering of a recommended treatment. There was also moderate evidence for a positive effect on the ordering of recommended diagnostic tests. There was conflicting evidence on the cost-effectiveness of CDS and on their acceptance by providers. But most telling was that use of the systems is relatively low, even in these high-tech environments.