Clinical Question

Do computerized decision support systems linked to electronic medical records (EMRs) improve patient outcomes?

Bottom Line

Despite several decades of the use of EMRs and computerized decision support systems, the overall quality of data supporting their use is poor and those data show these systems do not save lives or save money. Whether patient morbidity is improved is even less certain. (Level of Evidence = 1a)

Synopsis

The authors searched several databases to identify randomized trials that evaluated the effectiveness of computerized decision support systems linked to EMRs. They defined these systems as information systems that support clinical decision making and linked patient-specific information within an EMR. These systems facilitate practicing evidence-based medicine by stealth. Clinicians receive case-specific guidance messages based on rules or algorithms. Several authors independently and blindly determined study inclusion and study quality, and extracted data. They resolved disagreements by discussion. They ultimately included 28 randomized trials—nine assessed morbidity, 16 assessed mortality, and 17 reported economic outcomes. Overall, 18 studies evaluated clinical outcomes and 10 reported only economic data. The authors only included the studies that evaluated clinical outcomes for meta-analysis. Only one of the 18 studies was considered at low risk of bias. Of the nine studies (of nearly 14,000 patients) that assessed morbidity, the authors report that inconsistent and selective reporting of various outcomes threaten the data that suggest that computerized decision support systems appear to be associated with small degrees of improvement in morbidity. Sixteen trials of more than 37,000 patients found no overall effect on mortality (approximately 6% in each group). Finally, the studies reporting economic outcomes did not demonstrate any consistent cost savings associated with computerized decision support systems.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference: MojaLKwagKHLytrasTet alEffectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health.2014; 104( 12): e12– e22.