Open AccessEffectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis
Author(s) -
Lorenzo Moja,
Koren Hyogene Kwag,
Theodore Lytras,
Lorenzo Bertizzolo,
Linn Brandt,
Valentina Pecoraro,
Giulio Rigon,
Alberto Vaona,
Francesca Ruggiero,
Massimo Mangia,
Alfonso Iorio,
Ilkka Kunnamo,
Stefanos Bonovas
Publication year - 2014
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2014.302164
Subject(s) - medicine , clinical decision support system , context (archaeology) , medline , meta analysis , confidence interval , relative risk , randomized controlled trial , systematic review , clinical trial , decision support system , data mining , computer science , paleontology , political science , law , biology
We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I(2) = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I(2) = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes.