J Am Med Inform Assoc 6:104-114 doi:10.1136/jamia.1999.0060104
  • Focus on Implementing Guidelines
  • Review

Computer-based Guideline Implementation Systems

A Systematic Review of Functionality and Effectiveness

  1. Richard N Shiffman,
  2. Yischon Liaw,
  3. Cynthia A Brandt,
  4. Geoffrey J Corb
  1. Affiliation of the authors: Yale University, New Haven, Connecticut
  1. Correspondence and reprints: Richard N. Shiffman, MD, Center for Medical Informatics, Yale School of Medicine, P.O. Box 208009, New Haven, CT 06520-8009. e-mail: 〈richard.shiffman{at}
  • Received 14 August 1998
  • Accepted 13 November 1998


In this systematic review, the authors analyze the functionality provided by recent computer-based guideline implementation systems and characterize the effectiveness of the systems. Twenty-five studies published between 1992 and January 1998 were identified. Articles were included if the authors indicated an intent to implement guideline recommendations for clinicians and if the effectiveness of the system was evaluated. Provision of eight information management services and effects on guideline adherence, documentation, user satisfaction, and patient outcome were noted.

All systems provided patient-specific recommendations. In 19, recommendations were available concurrently with care. Explanation services were described for nine systems. Nine systems allowed interactive documentation, and 17 produced paper-based output. Communication services were present most often in systems integrated with electronic medical records. Registration, calculation, and aggregation services were infrequently reported. There were 10 controlled trials (9 randomized) and 10 time-series correlational studies. Guideline adherence improved in 14 of 18 systems in which it was measured. Documentation improved in 4 of 4 studies.


  • This work was supported in part by the National Library of Medicine through grants 1-R29-LM-05552 and T-15-LM-07056. Dr. Shiffman is a Robert Wood Johnson Generalist Physician Faculty Scholar.

  • * References 15 17 21 24 26 29 30 34 35.

  • References 20 22 25 26 28 29 31 34.

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