Randomised controlled trials (RCTs), conducted in a clinical setting, that randomised patients, encounters, practitioners or practices to an electronic decision support system (EDSS) intervention, and that reported objective or surrogate measures of patient outcomes or measurable variables with an indirect or unestablished connection to the targeted clinical outcome, were eligible for inclusion. An EDSS was defined as any system that provided electronic patient-specific information to support clinical decisions. Studies in which patients measured or assessed the outcomes were excluded.
The included studies, which were conducted in the USA, UK, Canada and Norway, enrolled patients with acute illnesses or acute exacerbation of chronic disease in a hospital setting, or enrolled patients presenting to primary care practitioners with severe chronic diseases. The studies assessed treatment decisions and diagnostic or planning decisions. The former included antibiotic prescribing, drug-dosing of anticoagulants, management of diabetes, and therapy for cardiovascular events and asthma; the latter related to diagnosis and management of asthma, chronic heart disease and hypertension, treatment of diabetes and depression, and diagnostic decisions for patients with respiratory failure. Most treatment decision support systems provided alerts and reminders for prescribing decisions, assisted with drug-dosing, or generated alerts during provider order entry. Diagnostic decisions were supported by EDSS that were designed to provide point-of-care access to evidence-based guidelines, focus attention on specific investigations, or assess the risk of complications of chronic conditions. The included studies assessed a variety of different outcomes, ranging from mortality and length of hospital stay to rates of optimal decision-making
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.