Table 1.

Characteristics of the included studies

Author (year)	Country	Hospitals, Study wards	Patient population	EMS vendor	Study description of CDSa	Data collection	Outcomes reported	Quality rating
Al-Sarawi et al (2009)41	Australia	3 Public, Multiple-ward	NR	EPAS	Alertsb	PCR	PE	2: Weak
Armada et al (2014)42	Spain	1 Teaching, ICU	Adult, Cardiac	FarmaTools Dominion	“Moderate”a	PCR	PE, LOS, Mo, Hm, SRE	6: Moderate
Colpaert et al (2006)43	Belgium	1 Teaching, ICU	Adult	Centricity Critical Care Clinisoft	“Moderate”a	PCR	PE, LOS, Hm	10: Strong
Han et al (2016)44	USA	1 Teaching, ICU	Adult	EPIC Systems Corp	None	Obs.	Mortality, LOS	7: Moderate
Hernandez et al (2015)45	France	1 Teaching, General	Adult, Orthopaedic	NR, Commercial	Alertsb	Obs.	PE, MAE	6: Moderate
Hinjosa-Amaya et al (2016)46	Mexico	1 Teaching, General	Adult + Paediatric	NR	NR	RCR	ME	7: Moderate
Holdsworth et al (2007)47	USA	1 Public, Multiple ward	Paediatric	Eclipsys System 2000	”Extensive”a	PCR	Hm	8: Moderate
Jheeta and Franklin (2017)48	UK	1 Teaching, General	Adult, Elderly	NR	Alertsb	Obs.	MAE	2: Weak
Joy et al (2012)49	USA	1 Public, Multiple ward	Adult + Paediatric	EPIC Systems Corp	NR	PCR	ME, Hm	5: Moderate
Jozefczyk et al (2013)50	USA	1 Teaching, ICU	Paediatric, Neonatal	McKesson’s Horizon Expert Orders	”Rudimentary”a	RCR	ME	4: Weak
Mills et al (2017)51	UK	1 Public, Multiple ward	Adult	NR, Commercial	Alertsb	RCR	LOS, PE, SRE	4: Weak
Oliveros et al (2016)52	Spain	1 Teaching, General	NR	Prescriwin	“Basic”a	RCR	MAE, SRE	4: Weak
Pontefract et al (2018)53	UK	3 NR, General	Adult	NR, Commercial	Variedc	PCR	PE	4: Weak
Shawahna et al (2011)54	Pakistan	1 Teaching, Multiple ward	Adult + Paediatric	NR	None	PCR	PE	5: Moderate
Van Doormaal et al (2009)55	Netherlands	2 Teaching, General	Adult	iSoft Medicator + Theriak	“Basic”a	PCR	LOS, ME, Hm	8: Moderate
Walsh et al (2008)56	USA	1 Public, Multiple ward	Paediatric	Sunrise Clinical Manager	Alertsb	PCR	ME, Hm, SRE	8: Moderate
Warrick et al (2011)57	USA	1 Public, ICU	Paediatric	ICIP	Alertsb	PCR	PE	4: Weak
Westbrook et al (2012)58	Australia	2 Teaching, General	Adult	CMPO + iSoft MedChart	Alertsb	PCR	PE, SRE	10: Strong

Abbreviations: CDS, Clinical Decision Support; CMPO, Cerner Millennium Power Orders; EMS, Electronic Medication System; EPAS, The Enterprise Patient Administration System; General, the study included only general wards; Hm, Harm; Multiple-ward, study included both general and intensive care wards; ICU/ED, the study included only intensive care or complicated patient wards (eg, oncology, neonate); ICIP, Intellivue Clinical Information Portfolio; PCR, Prospective Chart Review (charts were assessed during the normal course of daily work); PE, Prescribing Error; Public, the hospital was nonteaching, RCR, Retrospective Chart Review (archived charts were assessed in retrospect); LOS, length of stay; Mo, mortality; NR, not reported; Obs., direct observations conducted pre- and post-EMS implementation; SRE, quantitative reporting of system-related errors.

^aThe terms “basic,” “rudimentary,” “moderate,” and “extensive” are taken verbatim from study author. For a complete description of the EMS and CDS, see Supplementary Appendix SB.

^bMany studies did not provide a specific description of CDS, though they did mention some alert functionality, such as potential drug–allergy and drug–drug interactions.

^cThis study assessed the impact of 5 levels of CDS. For a complete description, please see Supplementary Appendix SB.