A significant gap exists between actual clinical practice and optimal patient care. For example, in a recent systematic review of the quality of health care in the United States, Schuster et al.
found that only about 70% of patients received recommended acute care, and that only about 60% of patients received recommended care for chronic conditions.1
Moreover, the Institute of Medicine recently estimated that 44,000 to 98,000 patients die each year in hospitals as a result of preventable medical errors.2
Even when using the lower estimate, this statistic implies that more Americans die each year from medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).3
Given this gap between actual clinical practice and ideal patient care, the Institute of Medicine and other key stakeholders have identified computerized physician order entry (CPOE) as an important strategy for improving professional practice and reducing medical errors.2
Indeed, by requiring clinicians to directly enter orders online, CPOE systems can virtually eliminate medical errors due to lost, incomplete, or illegible orders.4
Moreover, CPOE systems can significantly improve professional practice through the integration of clinical decision support systems (CDSSs). For example, a recent time series study found that a CPOE system with decision support features reduced the incidence of serious medication errors in a large hospital by 86%.5
While there is significant evidence for the effectiveness of CPOE-based CDSS interventions as a whole, little is known with regard to the specific CDSS elements that are most important in producing a desired change in clinician behavior. Thus, despite the insights gained from relevant qualitative studies,6
there remains a lack of evidence-based understanding as to why some CPOE-based CDSS interventions succeed, while others fail. Indeed, this is a problem that affects CDSS interventions in general,7
and we have conducted a systematic review of CDSSs provided both within and outside of CPOE systems in order to address this issue.8
The current systematic review represents a subset analysis of this larger work, in which special focus is placed on CDSSs provided in the context of CPOE systems. In undertaking this endeavor, our objective was to help guide the efforts of CPOE designers by providing a rigorous, evidence-based assessment of the CDSS features that are most effective at influencing clinician behavior in the context of computerized physician order entry.