Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings
This is a review of Monique W M Jaspers, Marian Smeulers, Hester Vermeulen, Linda W Peute 2011 article, “Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings”. 
This article summarized the impact of clinical decision support systems on the performance of medical practitioners and how they influence patient outcomes. Additionally, this article attempted to identify areas which would benefit from additional research.
Authors defined a literature search strategy that consist of research on different clinical libraries (Such as Medline, Embase, and Inspec) and performed analysis on the best systematic reviews focused on CDS. In order to implement this strategy, researchers defined a two-stage procedure, publication selection with use of predefined criteria and an independent assessment approach by the measurement tool. They included systematic reviews with AMSTAR score 9 or above and rated them based on their level of evidence by two independent reviewers.
Results and Conclusion
The research result showed that 48.57% (17 out of 35) of pre-included reviews were had adequate quality to further investigated. 57.14% (52 out of 91) of cases showed an evidence that CDS has impact on practitioner performance. Finally, only 30% (25 out of 82) studies of the systematic reviews showed a unique evidence that the CDS have a positive impact on patient outcomes. Researchers concluded that among few studies focused on any benefits of CDS on patient outcomes, many had had very small sample size or had a narrow time frame to show any clinically important effects. The study shows a significant evidence of positive CDS impact on healthcare providers' performance which affects drug ordering and preventive care reminder systems. The explanation behind this finding comes from the fact that these CDS types need a very small amount of patient information that are available before the diagnosis notes prepared. In fact, they are generated at the time clinicians make the decisions.
This important research took a serious important step toward showing tangible effectiveness of clinical decision support systems in practitioner performance and patient outcomes. Different systematic reviews have been analyzed and a brief outcome of the research objectives have been produced. Additionally, one important aspect of this research is that it focused on areas that need more attention to understand the CDS impact more effectively. Although this article present some limitations, and also used materials developed more than a decade ago, when CDS systems were difficult to use and were in their early stages of development, it shows a guide and road-map for future research areas.
The purpose of this article is to quantify what impact, if any, Clinical Decision Support Systems (CDSS) have had in the field of healthcare regarding the performance of practitioners as well as outcomes for the patient. 
Systematic reviews were performed on CDSS which have been deployed in hospital settings, and were accessed by “the 11-item measurement tool, AMSTAR”  and rated based on the findings of the two independent reviewers who analyzed the evidence.
Analysis of the various CDSS found the following results:
- 57% of CDSS significantly affected practitioner performance.
- 30% of CDSS affected patient outcomes in a positive manner.
The higher percentage of practitioner performance affected in contrast to patient outcomes affected is most likely due to the fact it is easier to prove positive practitioner performance modifications as “these types of CDSS require a minimum of patient data that are largely available before the advice is (to be) generated: at the time clinicians make the decisions.”  . Proving positive patient outcomes, however, takes requires long term studies each with a large sample size. The authors also note that integration of EMR and CDSS could positively enhance performance. They also suggest that the CDSS interventions be provided at the right time and with little disruption to the physicians workflow.
This article does a good job at demonstrating that CDSS are capable to generating positive outcomes for both health care practitioners and patients. The results did not demonstrate all CDSS had a positive impact for both practitioner performance and patient outcomes ; but these numbers can only be expected to increase as more time and effort is placed into researching scenarios where CDSS may be beneficial and designing an effective system which may accomplish this task. The employment of systematic reviews is an example of the use of high quality Evidence Based Medicine (EBM) techniques to inform CDSS and ultimately help to improve the quality of healthcare outcomes.
- Monique W M Jaspers, Marian Smeulers, Hester Vermeulen, Linda W Peute. 2011 Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. http://jamia.oxfordjournals.org/content/18/3/327
- Jaspers, M. W., Smeulers, M., Vermeulen, H., & Peute, L. W. (2011). Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. Journal of the American Medical Informatics Association, 18(3), 327-334. http://jamia.oxfordjournals.org/content/18/3/327
- Shea, B. J., Hamel, C., Wells, G. A., Bouter, L. M., Kristjansson, E., Grimshaw, J., … Boers, M. (2009). AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Journal of Clinical Epidemiology, 62(10), 1013–1020. doi:10.1016/j.jclinepi.2008.10.009