Table 2.
Summary of key findings from qualitative and quantitative evidence
| Durations of consultations when using eCDS tools | Potential explanatory factors highlighted |
|---|---|
| Perceived duration (mainly qualitative studies) n = 72 | |
| Perceived increase in duration (n = 36) [15, 16, 27, 28, 30–32, 34–37, 41, 44, 47, 50, 53, 61, 71, 77, 78, 83, 89, 92, 93, 96, 97, 101, 102, 104, 107, 110, 112, 115, 117, 124] |
Existing time/workload pressures [16, 27, 28, 30, 31, 36, 41, 44, 47, 50, 71, 77, 78, 89, 93, 96, 97, 101, 104, 107, 110, 112, 115, 117, 124, 131]; eCDS tools will add burden [92, 104] No time for preventive care [32] Workflow disruption [30, 83, 93, 102, 104]; interruptive alerts/functions [117] Slow software [35, 37, 61]; being a separate system to EMR [16, 34, 71] Change to the trajectory of conversation with patient [15, 53, 104] Increased consultation duration might be ‘acceptable’ in some cases |
| Perceived decrease in duration (n = 6) [62, 67, 67, 131] |
eCDS tools that were seen to improve efficiency [62, 69, 81] Tools designed to support patient management (rather than diagnosis) [69, 81, 98, 118] Tools that were embedded in the EMR [62, 81, 118] Reduced need for data entry [81, 98] Fitting with usual workflow [118] |
| Perception of no impact on duration (n = 4) [42, 63, 114, 127] |
No obvious explanatory factors highlighted Low number of instances where a cardiovascular (CV) risk eCDS tool indicated high risk [63] Tools that guide the whole consultation and that were non-interruptive [42, 108, 127] |
| Objectively-measured duration (mainly quantitative studies) n = 26 | |
| Increased duration (n = 3) [38, 54, 117] | An eCDS tool which took longer than the length of a typical consultation [54] |
| Decreased duration (n = 4) [116, 120–122] |
eCDS tools that helped speed up certain tasks, e.g. calculating CV risk [116, 120] and clinical decision-making, asthma chart review [121] Tools designed to support management rather than diagnosis [116, 121, 122] |
| No impact on duration (n = 9) [40, 48, 57, 84, 95, 103, 109, 119] |
Fitting in with usual workflow 100 Low usage of the study tool |
Keywords identified from initial search:
•General practice / primary care
•Decision [making] [support]
•Computer / Online / Electronic
•Tool / System / Prompt
•Risk [assessment]
•Consultation / appointment