Scope and Influence of Electronic Health Record–Integrated Clinical Decision Support in the Emergency Department: A Systematic Review - 20/07/19
, Michael S. Pulia, MD, MS a, Shashank Ravi, MD e, Peter L.T. Hoonakker, PhD b, Ann Schoofs Hundt, PhD b, Douglas Wiegmann, PhD b, d, Emily J. Wirkus, MPH b, Stephen Johnson, MLS c, Pascale Carayon, PhD b, dAbstract |
Study objective |
As electronic health records evolve, integration of computerized clinical decision support offers the promise of sorting, collecting, and presenting this information to improve patient care. We conducted a systematic review to examine the scope and influence of electronic health record–integrated clinical decision support technologies implemented in the emergency department (ED).
Methods |
A literature search was conducted in 4 databases from their inception through January 18, 2018: PubMed, Scopus, the Cumulative Index of Nursing and Allied Health, and Cochrane Central. Studies were included if they examined the effect of a decision support intervention that was implemented in a comprehensive electronic health record in the ED setting. Standardized data collection forms were developed and used to abstract study information and assess risk of bias.
Results |
A total of 2,558 potential studies were identified after removal of duplicates. Of these, 42 met inclusion criteria. Common targets for clinical decision support intervention included medication and radiology ordering practices, as well as more comprehensive systems supporting diagnosis and treatment for specific disease entities. The majority of studies (83%) reported positive effects on outcomes studied. Most studies (76%) used a pre-post experimental design, with only 3 (7%) randomized controlled trials.
Conclusion |
Numerous studies suggest that clinical decision support interventions are effective in changing physician practice with respect to process outcomes such as guideline adherence; however, many studies are small and poorly controlled. Future studies should consider the inclusion of more specific information in regard to design choices, attempt to improve on uncontrolled before-after designs, and focus on clinically relevant outcomes wherever possible.
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| Please see page 286 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: David L. Schriger, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: BWP, PLTH, ASH, and PC conceived and designed the study. BWP and SJ designed the search strategy, which was executed by SJ. BWP, MSP, SR, PLTH, ASH, DW, EJW, and PC participated in review and selection of studies and data abstraction from studies. BWP drafted the article, and all authors contributed substantially to its revision. BWP takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This research was supported by funding from the Agency for Healthcare Research and Quality (AHRQ), grants R01HS022086 (PC), K08HS024558 (BP), and K08HS024342(MSP); and was supported by the Clinical and Translational Science Award program through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences, grant UL1TR000427. |
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| The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or the NIH. |
Vol 74 - N° 2
P. 285-296 - août 2019 Retour au numéro
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