General system features associated with improvements in clinical practice

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In a seminal study Kawamoto et al. [1], found that 75% of clinical decision support interventions succeeded when the decision support was provided to clinicians automatically, whereas none succeeded when clinicians were required to seek out the advice of the decision support system (rate difference 75% (37% to 84%)). Similarly, systems that were provided as an integrated component of charting or order entry systems were significantly more likely to succeed than stand alone systems (rate difference 37% (6% to 61%)); systems that used a computer to generate the decision support were significantly more effective than systems that relied on manual processes (rate difference 26% (2% to 49%)); systems that prompted clinicians to record a reason when not following the advised course of action were significantly more likely to succeed than systems that allowed the system advice to be bypassed without recording a reason (rate difference 41% (19% to 54%)); and systems that provided a recommendation (such as “Patient is at high risk of coronary artery disease; recommend initiation of β blocker therapy”) were significantly more likely to succeed than systems that provided only an assessment of the patient (such as “Patient is at high risk of coronary artery disease”) (rate difference 35% (8% to 58%)).

Finally, systems that provided decision support at the time and location of decision making were substantially more likely to succeed than systems that did not provide advice at the point of care, but the difference in success rates fell just short of being significant at the 0.05 level (rate difference 48% (-0.46% to 70.01%)).


[1] Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(7494):765.

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