Computer-based Guideline Implementation Systems: A Systematic Review of Functionality and Effectiveness

Abstract

In this systematic review, the authors analyze the functionality provided by recent computer-based guideline implementation systems and characterize the effectiveness of the systems. Twenty-five studies published between 1992 and January 1998 were identified. Articles were included if the authors indicated an intent to implement guideline recommendations for clinicians and if the effectiveness of the system was evaluated. Provision of eight information management services and effects on guideline adherence, documentation, user satisfaction, and patient outcome were noted. All systems provided patient-specific recommendations. In 19, recommendations were available concurrently with care. Explanation services were described for nine systems. Nine systems allowed interactive documentation, and 17 produced paper-based output. Communication services were present most often in systems integrated with electronic medical records. Registration, calculation, and aggregation services were infrequently reported. There were 10 controlled trials (9 randomized) and 10 time-series correlational studies. Guideline adherence improved in 14 of 18 systems in which it was measured. Documentation improved in 4 of 4 studies.

Changing Clinical Practice Through Patient Specific Reminders Available at the Time of the Clinical Encounter: Systematic Review and Meta-Analysis

“…Previous studies have found that the response of clinicians to such reminders is variable, and a number of reviews have described existing tools, where possible measured their impact, and in some cases attempted to identify factors influencing effect size. [1][2][3][4][5][6][7][8][9][10][11] Reminder systems are diverse in their design. Some are used to support specific clinical areas of care (e.g.…”

Assessing the strengths and weaknesses of a computer assisted medication review in hospitalized patients

“…When the CDSS performs these processes at the background the manual medication surveillance can become more focused on other specific challenges during drug treatment. Previous studies showed that systems in which the physician had to enter all data manually were less likely to succeed and performed no better than physicians who did not use the CDSS, [13,15]. Also, manual data entry can cause incomplete and incorrect registration and consequently lead to an inferior CDSS.…”

“…Decision support systems can help to monitor these errors but can also help to educate professionals by providing links to guidelines when a drug is prescribed. A major challenge in developing a CDSS is the implementation of the system in daily practice, [15,16]. Factors associated with failure to implement a CDSS are user's dissatisfaction, disruption of workflow, failure to integrate the CDSS with the electronic patient data, low specificity and sensitivity of the alerts given by the CDSS, burden of manual data entry, incompatibility with guidelines, system immaturity and failure to update, [15,16].…”

Evaluation of the Decision Support Systems

“…[11];  the levels of evidence of the recommendations used: it must be clear (levels 1 to 5) and well taken into account by the algorithms of the inference engine;  it should be noted that there are recommendations for the evaluation of good practice guides [12];  it should also be checked whether a procedure for the practical updating of knowledge and rules has been arranged as the reliability of knowledge depends on their continuous updating. This must also be evaluated.…”