Abstract
BackgroundComputerized decision support systems (CDSS) are believed to have the potential to improve the quality of health care delivery, although results from high quality studies have been mixed. We conducted a systematic review to evaluate whether certain features of prescribing decision support systems (RxCDSS) predict successful implementation, change in provider behaviour, and change in patient outcomes.MethodsA literature search of Medline, EMBASE, CINAHL and INSPEC databases (earliest entry to June 2008) was conducted to identify randomized controlled trials involving RxCDSS. Each citation was independently assessed by two reviewers for outcomes and 28 predefined system features. Statistical analysis of associations between system features and success of outcomes was planned.ResultsOf 4534 citations returned by the search, 41 met the inclusion criteria. Of these, 37 reported successful system implementations, 25 reported success at changing health care provider behaviour, and 5 noted improvements in patient outcomes. A mean of 17 features per study were mentioned. The statistical analysis could not be completed due primarily to the small number of studies and lack of diversity of outcomes. Descriptive analysis did not confirm any feature to be more prevalent in successful trials relative to unsuccessful ones for implementation, provider behaviour or patient outcomes.ConclusionWhile RxCDSSs have the potential to change health care provider behaviour, very few high quality studies show improvement in patient outcomes. Furthermore, the features of the RxCDSS associated with success (or failure) are poorly described, thus making it difficult for system design and implementation to improve.
Highlights
Computerized decision support systems (CDSS) are believed to have the potential to improve the quality of health care delivery, results from high quality studies have been mixed
We only considered systems which intervened before a drug therapy had been chosen by a physician, or had the ability to suggest alternate therapies to be a RxCDSS
Our objective was to conduct a systematic review of randomized trials, to evaluate the effectiveness of RxCDSS using a hierarchical approach to defining success, and to Search Strategy We searched the databases Medline, EMBASE, CINAHL, and INSPEC for articles published since the earliest entry
Summary
Computerized decision support systems (CDSS) are believed to have the potential to improve the quality of health care delivery, results from high quality studies have been mixed. The suggestion that detection of preventable errors by health care professionals could improve patient safety and reduce the cost of adverse drug events [3], has been sufficient to spawn a multitude of medication safety initiatives with limited rigorous evaluation of their benefits and harms. They have several uses, the main interest in electronic health records (EHR) and computerized decision support systems (CDSS) is to improve patient outcomes by influencing the decision making process of providers [4,5,6]. These systems may include, but do not require, a formal e-prescribing link with pharmacies
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