Cresswell Kathrin, Majeed Azeem, Bates David W, Sheikh Aziz
Centre for Population Health Sciences, University of Edinburgh, UK.
Inform Prim Care. 2012;20(2):115-28. doi: 10.14236/jhi.v20i2.32.
Computerised decision support systems are designed to support clinicians in making decisions and thereby enhance the quality and safety of care. We aimed to undertake an interpretative review of the empirical evidence on computerised decision support systems, their contexts of use, and summarise evidence on the effectiveness of these tools and insights into how these can be successfully implemented and adopted.
We systematically searched the empirical literature to identify systematic literature reviews on computerised decision support applications and their impact on the quality and safety of healthcare delivery over a 13-year period (1997-2010). The databases searched included: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, The Health Technology Assessment Database, and The National Health Service (NHS) Economic Evaluation Database. To be eligible for inclusion, systematic reviews needed to address computerised decision support systems, and at least one of the following: impact on safety; quality; or organisational, implementation or adoption considerations.
Our searches yielded 121 systematic reviews relating to eHealth, of which we identified 41 as investigating computerised decision support systems. These indicated that, whilst there was a lack of investigating potential risks, such tools can result in improvements in practitioner performance in the promotion of preventive care and guideline adherence, particularly if specific information is available in real time and systems are effectively integrated into clinical workflows. However, the evidence regarding impact on patient outcomes was less clear-cut with reviews finding either no, inconsistent or modest benefits.
Whilst the potential of clinical decision support systems in improving, in particular, practitioner performance is considerable, such technology may also introduce new risks resulting not only from technical challenges (such as data inaccuracies) but also from disruption of clinical workflows. Moving forward, there is a need for system development, procurement and implementation to be characterised by a user 'pull' and then tailor systems to the needs of users.
计算机化决策支持系统旨在辅助临床医生进行决策，从而提高医疗质量与安全性。我们旨在对有关计算机化决策支持系统及其使用环境的实证证据进行解释性综述，并总结这些工具有效性的证据以及如何成功实施和采用这些工具的见解。
我们系统地检索了实证文献，以识别关于计算机化决策支持应用及其在13年期间（1997 - 2010年）对医疗服务质量和安全性影响的系统文献综述。检索的数据库包括：医学索引数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、考克兰系统评价数据库、效果评价文摘数据库、考克兰对照试验中心注册库、考克兰方法学注册库、卫生技术评估数据库以及英国国家医疗服务体系（NHS）经济评估数据库。为符合纳入标准，系统综述需涉及计算机化决策支持系统，且至少涉及以下其中一项：对安全性的影响；质量；或组织、实施或采用方面的考虑因素。
我们的检索产生了121篇与电子健康相关的系统综述，其中我们确定有41篇是对计算机化决策支持系统进行研究的。这些综述表明，虽然缺乏对潜在风险的研究，但此类工具可提高从业者在促进预防保健和遵循指南方面的表现，特别是如果能实时获取特定信息且系统有效整合到临床工作流程中。然而，关于对患者结局影响的证据则不太明确，综述发现要么没有益处、益处不一致，要么益处不大。
虽然临床决策支持系统在改善从业者表现方面的潜力巨大，但此类技术也可能带来新风险，这些风险不仅源于技术挑战（如数据不准确），还源于临床工作流程的中断。展望未来，系统开发、采购和实施需要以用户“拉动”为特征，然后根据用户需求定制系统。
