The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering

摘要

Context.—Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospitalstays.Objective.—To evaluate the effect of computerized clinical decision support systems on appropriateness oflaboratory test ordering.Data Sources.—We used MEDLINE, Embase, CINAHL,MEDLINE In-Process and Other Non-Indexed Citations,Clinicaltrials.gov, Cochrane Library, and Inspec throughDecember 2015. Investigators independently screenedarticles to identify randomized trials that assessed acomputerized clinical decision support system aimed atimproving laboratory test ordering by providing patientspecific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics.Conclusions.—Because of heterogeneity of systems andsettings, pooled estimates of effect could not be made.Data showed that computerized clinical decision supportsystems had little or no effect on clinical outcomes butsome effect on compliance. Computerized clinical decisionsupport systems targeted at laboratory test ordering formultiple conditions appear to be more effective than those targeted at a single condition.