Effect of Clinical Decision-Support Systems: A Systematic Review
Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, et al. Effect of Clinical Decision-Support Systems: A Systematic Review. Ann Intern Med. 2012;157:29-43. 
The authors did a systematic review to evaluate the impact that clinical decision support (CDS) systems have on health care processes, clinical outcomes, workload and efficiency, costs, provider use and implementation, including patient satisfaction.
Does clinical decision support impact health care processes? What will be the effect of CDS on clinical outcomes, workload and efficiency, cost and cost-effectiveness, provider use and implementation, including patient satisfaction?
Tiffani Bright et al searched MEDLINE (accessed through PubMed), CINAHL, PsycINFO and Web of Science databases for studies that were done between January 1976 and January 2011. The studies identified included randomized controlled trials of CDS systems that were implemented in a real clinical setting and assisted with decision-making by healthcare providers at the point of care. The studies assessed and reported different types of outcomes, including health care process measures, user workload and efficiency, cost and cost-effectiveness, provider use and implementation, patient satisfaction and clinical outcomes. Data collected from all studies examined were synthesized and quantitatively analyzed. Summary estimates were calculated using the random-effects model often used for meta-analysis of clinical studies.
From all the studies examined, important findings, including the strength of supporting evidence of these findings were stated and summarized. With regard to clinical outcomes assessed, the evidence strength for length of stay, mortality, health-related quality of life (HRQOL) and adverse events was low while the evidence strength for morbidity was moderate. For health care process measure, the evidence strength was high for recommended preventive care service and treatment ordered or completed; moderate for recommended clinical study ordered or completed. For user workload and efficiency, there was insufficient evidence that CDS systems had an effect on user knowledge, clinical workload and the number of patients seen per unit time. There was limited evidence that CDS systems demonstrated a trend toward improving efficiency. In terms of patient satisfaction, there was limited evidence that clinician use of CDS systems had a positive effect. There was modest evidence that use of CDS systems lowered treatment costs, total costs, and promoted cost savings. There was insufficient evidence to support cost-effectiveness. Looking at use and implementation outcomes, there was low evidence on health care provider acceptance and health care provider use of CDS systems. There was moderate evidence that CDS systems fostered high satisfaction among healthcare providers. There was insufficient evidence for how CDS systems affected implementation.
Conclusion & Discussion
Several reviews have examined the effects of CDS systems in healthcare from cost-justification to performance improvement. While cost reduction and savings have been realized in some healthcare settings, more studies and literature are still needed to show more evidence of cost benefits of CDS systems. This systematic review showed that CDS systems had a favorable effect on some outcome measures and very little or no effect on others. There was a favorable impact on recommended preventive services and treatments. The review showed strong evidence from academic, community and Veteran Administration inpatient and ambulatory settings that had CDS systems integrated in Computer Provider Order Entry (CPOE) or Electronic Health Record (EHR) systems. With regard to the effects of CDS systems on clinical and economic outcomes, data were sparse in this study. Nevertheless, CDS systems show considerable benefits in healthcare.
Additional research goes into depth to identify practitioner performance and patient outcomes based of CDSS. 
- Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR, et al. Effect of Clinical Decision-Support Systems: A Systematic Review. Ann Intern Med. 2012;157:29-43. Retrieved from http://annals.org/article.aspx?articleid=1206700
- Garg AX, Adhikari NJ, McDonald H, et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review. JAMA.2005;293(10):1223-1238. http://jama.jamanetwork.com/article.aspx?articleid=200503&resultClick=3