Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis

Lorenzo Moja, Koren H. Kwag, Theodore Lytras, Lorenzo Bertizzolo, Linn Brandt, Valentina Pecoraro, Giulio Rigon, Alberto Vaona, Francesca Ruggiero, Massimo Mangia, Alfonso Iorio, Ilkka Kunnamo, Stefanos Bonovas

Research output: Contribution to journalArticlepeer-review

Abstract

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness ofcomputerized 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; I2 = 41%).Astatistically significant effect was evident in the prevention ofmorbidity, any disease (9 RCTs; 13868 patients;RR = 0.82; 95% CI = 0.68, 0.99; I2 = 64%), but selectiveoutcomereporting 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 improvemorbidity outcomes.

Original languageEnglish
Pages (from-to)e12-e22
JournalAmerican Journal of Public Health
Volume104
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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