Table 5.
Success rates* of clinical decision support systems (CDSS) with and without 15 potentially important features. Results of 71 control-CDSS comparisons
|
%success rate (95% CI)
|
||||
|---|---|---|---|---|
| Feature | Feature prevalence (%) | With feature | Without feature | Rate difference (95% CI) |
| General system features | ||||
| Integration with charting or order entry system | 85 | 73 (61 to 84) | 36 (14 to 67) | 37 (6 to 61)† |
| Computer based generation of decision support | 69 | 76 (62 to 87) | 50 (28 to 72) | 26 (2 to 49)† |
| Local user involvement in development process | 7 | 40 (8 to 81) | 70 (58 to 80) | −30 (−61 to 11) |
| Clinician-system interaction features | ||||
| Automatic provision of decision support as part of clinician workflow | 90 | 75 (63 to 85) | 0 (0 to 38) | 75 (37 to 84)† |
| Provision at time and location of decision making | 89 | 73 (61 to 83) | 25 (5 to 65) | 48 (0 to 70)‡ |
| Request documentation of reason for not following system recommendations | 21 | 100 (79 to 100) | 59 (45 to 72) | 41 (19 to 54)† |
| No need for additional clinician data entry | 89 | 71 (59 to 82) | 38 (11 to 71) | 34 (−2 to 61) |
| Recommendations executed by noting agreement | 13 | 78 (44 to 96) | 66 (54 to 77) | 12 (−23 to 34) |
| Communication content features | ||||
| Provision of a recommendation, not just an assessment | 76 | 76 (63 to 86) | 41 (18 to 66) | 35 (8 to 58)† |
| Promotion of action rather than inaction | 92 | 68 (56 to 78) | 67 (27 to 94) | 1 (−27 to 40) |
| Justification via provision of research evidence | 7 | 100 (50 to 100) | 65 (53 to 76) | 35 (−13 to 48) |
| Justification via provision of reasoning | 39 | 75 (56 to 89) | 63 (47 to 76) | 12 (−11 to 34) |
| Auxiliary features | ||||
| Provision of decision support results to both clinicians and to patients | 10 | 86 (45 to 99) | 66 (54 to 77) | 20 (−23 to 39) |
| CDSS accompanied by periodic performance feedback | 4 | 67 (14 to 98) | 68 (55 to 78) | −1 (−50 to 31) |
| CDSS accompanied by conventional education | 31 | 55 (33 to 74) | 73 (60 to 84) | −19 (−42 to 4) |
* Success defined as statistically and clinically significant improvement in clinical practice. †Difference between success rates statistically significant. ‡Lower bound of 95% confidence interval=−0.46%.