Both commercially and locally developed clinical decision support systems (CDSS) are effective at improving healthcare process measures across diverse settings, but evidence for clinical, economic, workload and efficiency outcomes remains sparse, according to an Annals of Internal Medicine article published online April 23.

Tiffani J. Bright, PhD, Duke University School of Medicine in Durham, N.C., and colleagues sought to evaluate the effect of CDSS on clinical outcomes, healthcare processes, workload and efficiency, patient satisfaction, cost and provider use and implementation.

The researchers screened reports to identify randomized trials published in English of electronic CDSS that were implemented in clinical settings; used by providers to aid decision making at the point of care; and reported clinical, healthcare process, workload, relationship-centered, economic, or provider use outcomes.

Out of 15,176 screened abstracts, 148 randomized, controlled trials were included. A total of 128 assessed healthcare process measures, 29 assessed clinical outcomes and 22 measured costs.

“Both commercially and locally developed CDSS improved healthcare process measures related to performing preventive services (25 patients), ordering clinical studies (20 patients) and prescribing therapies (46 patients)," the researchers said.

Few studies measured potential unintended consequences or adverse effects, the report found.

The authors acknowledged the study had limitations including the heterogeneity of the studies' limited general observations about CDSS. “Broad penetration of clinical decision-support tools will require aggressively seeking a better understanding of what the right information is and when and how it should be delivered to the right person, and a critical examination of the unintended consequences of CDSS implementation,” the authors concluded.