J Am Med Inform Assoc 18:327-334 doi:10.1136/amiajnl-2011-000094
  • Review

Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings

Editor's Choice
  1. Linda W Peute1
  1. 1Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Monique W M Jaspers, Department of Medical Informatics, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands; m.w.jaspers{at}
  • Received 15 July 2010
  • Accepted 2 January 2011
  • Published Online First 21 March 2011


Objective To synthesize the literature on clinical decision-support systems' (CDSS) impact on healthcare practitioner performance and patient outcomes.

Design Literature search on Medline, Embase, Inspec, Cinahl, Cochrane/Dare and analysis of high-quality systematic reviews (SRs) on CDSS in hospital settings. Two-stage inclusion procedure: (1) selection of publications on predefined inclusion criteria; (2) independent methodological assessment of preincluded SRs by the 11-item measurement tool, AMSTAR. Inclusion of SRs with AMSTAR score 9 or above. SRs were thereafter rated on level of evidence. Each stage was performed by two independent reviewers.

Results 17 out of 35 preincluded SRs were of high methodological quality and further analyzed. Evidence that CDSS significantly impacted practitioner performance was found in 52 out of 91 unique studies of the 16 SRs examining this effect (57%). Only 25 out of 82 unique studies of the 16 SRs reported evidence that CDSS positively impacted patient outcomes (30%).

Conclusions Few studies have found any benefits on patient outcomes, though many of these have been too small in sample size or too short in time to reveal clinically important effects. There is significant evidence that CDSS can positively impact healthcare providers' performance with drug ordering and preventive care reminder systems as most clear examples. These outcomes may be explained by the fact that 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.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed

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