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Clinical decision support systems (CDSS) have become a leading response to this report, and to the growing demand for the promotion of standards-based care delivery. The objective of this paper is to evaluate the recent literature for both the types and effectiveness of electronic CDSS in the primary care setting.\nMETHODS: An electronic search of the literature was conducted utilising MEDLINE (1996-2006), CINAHL (1982-2006) and all EBM Reviews--Cochrane DSR, ACP Journal Club, DARE and CCTR. The search included various combinations of the MeSH search terms 'clinical decision support systems', 'primary health care', 'ambulatory care' and 'practice guidelines' and was limited to articles published from 2000 to 2006. Studies were selected for review if they involved either non-randomised observational or randomised controlled trials (RCTs) utilising CDSS as a single intervention, were performed in an ambulatory primary care setting and included quantifiable outcome measures.\nRESULTS: Seventeen studies were included in the review, including five non-randomised observational studies and 12 RCTs. Thirteen studies (76%) found either positive or variable outcomes related to CDSS intervention with four studies (24%) showing no significant effect.\nCONCLUSION: Although there is validation that CDSS has the potential to produce statistically significant improvement in outcomes, there is much variability among the types and methods of CDSS implementation and resulting effectiveness. As CDSS will likely continue to be at the forefront of the march toward effective standards-based care, more work needs to be done to determine effective implementation strategies for the use of CDSS across multiple settings and patient populations.", "publicationTitle": "Informatics in primary care", "publisher": "", "place": "", "date": "2008", "volume": "16", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "79-91", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Inform Prim Care", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1476-0320", "archive": "", "archiveLocation": "", "shortTitle": "The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 18713524", "tags": [ { "tag": "Ambulatory Care", "type": 1 }, { "tag": "Decision Support Systems, Clinical", "type": 1 }, { "tag": "Disease Management", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Outcome and Process Assessment (Health Care)", "type": 1 }, { "tag": "Practice Guidelines as Topic", "type": 1 }, { "tag": "Primary Health Care", "type": 1 }, { "tag": "Quality of Health Care", "type": 1 }, { "tag": "Reminder Systems", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2013-09-30T17:53:22Z", "dateModified": "2013-09-30T17:53:22Z" } }, { "key": "ICWIW643", "version": 4437, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/ICWIW643", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/ICWIW643", "type": "text/html" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } }, "creatorSummary": "Gentles et al.", "numChildren": 1 }, "data": { "key": "ICWIW643", "version": 4437, "itemType": "journalArticle", "title": "Health Information Technology to Facilitate Communication Involving Health Care Providers, Caregivers, and Pediatric Patients: A Scoping Review", "creators": [ { "creatorType": "author", "firstName": "Stephen James", "lastName": "Gentles" }, { "creatorType": "author", "firstName": "Cynthia", "lastName": "Lokker" }, { "creatorType": "author", "firstName": "K Ann", "lastName": "McKibbon" } ], "abstractNote": "", "publicationTitle": "", "publisher": "", "place": "", "date": "", "volume": "12", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Med Internet Res", "DOI": "10.2196/jmir.1390", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "Health Information Technology to Facilitate Communication Involving Health Care Providers, Caregivers, and Pediatric Patients", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "PMID: 20562092\nPMCID: 2956233", "tags": [], "collections": [], "relations": {}, "dateAdded": "2013-09-30T17:53:22Z", "dateModified": "2013-09-30T17:53:22Z" } }, { "key": "T6UPS4G8", "version": 1, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/T6UPS4G8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/T6UPS4G8", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/23443/items/GAJZUFE2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } } }, "data": { "key": "T6UPS4G8", "version": 1, "parentItem": "GAJZUFE2", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Central Link", "accessDate": "2010-09-07T00:18:30Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557136/", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2010-09-07T00:18:30Z", "dateModified": "2010-09-07T00:18:30Z" } }, { "key": "GAJZUFE2", "version": 1, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/GAJZUFE2", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/GAJZUFE2", "type": "text/html" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } }, "creatorSummary": "Doebbeling et al.", "parsedDate": "2006-02", "numChildren": 1 }, "data": { "key": "GAJZUFE2", "version": 1, "itemType": "journalArticle", "title": "Priorities and Strategies for the Implementation of Integrated Informatics and Communications Technology to Improve Evidence-Based Practice", "creators": [ { "creatorType": "author", "firstName": "Bradley N", "lastName": "Doebbeling" }, { "creatorType": "author", "firstName": "Ann F", "lastName": "Chou" }, { "creatorType": "author", "firstName": "William M", "lastName": "Tierney" } ], "abstractNote": "The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.", "publicationTitle": "Journal of General Internal Medicine", "publisher": "", "place": "", "date": "2006-2", "volume": "21", "issue": "S2", "section": "", "partNumber": "", "partTitle": "", "pages": "S50-S57", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Gen Intern Med", "DOI": "10.1111/j.1525-1497.2006.00363.x", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0884-8734", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "PMID: 16637961\nPMCID: 2557136", "tags": [], "collections": [ "PWHU78HD" ], "relations": {}, "dateAdded": "2010-09-07T00:18:29Z", "dateModified": "2010-09-07T00:18:29Z" } }, { "key": "G4CQWTIU", "version": 1, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/G4CQWTIU", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/G4CQWTIU", "type": "text/html" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } }, "creatorSummary": "Zheng et al.", "parsedDate": "2010-07-01", "numChildren": 0 }, "data": { "key": "G4CQWTIU", "version": 1, "itemType": "journalArticle", "title": "Quantifying the impact of health IT implementations on clinical workflow: a new methodological perspective", "creators": [ { "creatorType": "author", "firstName": "Kai", "lastName": "Zheng" }, { "creatorType": "author", "firstName": "Hilary M", "lastName": "Haftel" }, { "creatorType": "author", "firstName": "Ronald B", "lastName": "Hirschl" }, { "creatorType": "author", "firstName": "Michael", "lastName": "O'Reilly" }, { "creatorType": "author", "firstName": "David A", "lastName": "Hanauer" } ], "abstractNote": "Health IT implementations often introduce radical changes to clinical work processes and workflow. Prior research investigating this effect has shown conflicting results. Recent time and motion studies have consistently found that this impact is negligible; whereas qualitative studies have repeatedly revealed negative end-user perceptions suggesting decreased efficiency and disrupted workflow.We speculate that this discrepancy may be due in part to the design of the time and motion studies, which is focused on measuring clinicians' ‘time expenditures’ among different clinical activities rather than inspecting clinical ‘workflow’ from the true ‘flow of the work’ perspective. In this paper, we present a set of new analytical methods consisting of workflow fragmentation assessments, pattern recognition, and data visualization, which are accordingly designed to uncover hidden regularities embedded in the flow of the work. Through an empirical study, we demonstrate the potential value of these new methods in enriching workflow analysis in clinical settings.", "publicationTitle": "Journal of the American Medical Informatics Association", "publisher": "", "place": "", "date": "Julio 01 , 2010", "volume": "17", "issue": "4", "section": "", "partNumber": "", "partTitle": "", "pages": "454 -461", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "10.1136/jamia.2010.004440", "citationKey": "", "url": "http://jamia.bmj.com:0/content/17/4/454.abstract", "accessDate": "2010-09-01T03:01:19Z", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "Quantifying the impact of health IT implementations on clinical workflow", "language": "", "libraryCatalog": "Highwire 2.0", "callNumber": "0000", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2010-09-01T03:02:27Z", "dateModified": "2010-09-01T03:02:27Z" } }, { "key": "623TSUT9", "version": 1, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/623TSUT9", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/623TSUT9", "type": "text/html" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } }, "creatorSummary": "Samoocha et al.", "parsedDate": "2010", "numChildren": 0 }, "data": { "key": "623TSUT9", "version": 1, "itemType": "journalArticle", "title": "Effectiveness of Web-based Interventions on Patient Empowerment: A Systematic Review and Meta-analysis", "creators": [ { "creatorType": "author", "firstName": "David", "lastName": "Samoocha" }, { "creatorType": "author", "firstName": "David J", "lastName": "Bruinvels" }, { "creatorType": "author", "firstName": "Nieke A", "lastName": "Elbers" }, { "creatorType": "author", "firstName": "Johannes R", "lastName": "Anema" }, { "creatorType": "author", "firstName": "Allard J", "lastName": "van der Beek" } ], "abstractNote": "", "publicationTitle": "Journal of Medical Internet Research", "publisher": "", "place": "", "date": "06/2010", "volume": "12", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Med Internet Res", "DOI": "10.2196/jmir.1286", "citationKey": "", "url": "http://www.jmir.org/2010/2/e23/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%253A+JMedInternetRes+%2528Journal+of+Medical+Internet+Research+%2528atom%2529%2529&utm_content=Google+Reader", "accessDate": "2010-08-19T00:47:25Z", "PMID": "", "PMCID": "", "ISSN": "1438-8871", "archive": "", "archiveLocation": "", "shortTitle": "Effectiveness of Web-based Interventions on Patient Empowerment", "language": "", "libraryCatalog": "CrossRef", "callNumber": "0000", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2010-08-19T00:47:25Z", "dateModified": "2010-08-19T00:47:26Z" } }, { "key": "EHRH97QA", "version": 1, "library": { "type": "group", "id": 23443, "name": "Health-informatics", "links": { "alternate": { "href": "https://www.zotero.org/groups/health-informatics", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/23443/items/EHRH97QA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/health-informatics/items/EHRH97QA", "type": "text/html" } }, "meta": { "createdByUser": { "id": 320035, "username": "msotod", "name": "Mauricio Soto", "links": { "alternate": { "href": "https://www.zotero.org/msotod", "type": "text/html" } } }, "creatorSummary": "Van De Belt et al.", "parsedDate": "2010", "numChildren": 0 }, "data": { "key": "EHRH97QA", "version": 1, "itemType": "journalArticle", "title": "Definition of Health 2.0 and Medicine 2.0: A Systematic Review", "creators": [ { "creatorType": "author", "firstName": "Tom H", "lastName": "Van De Belt" }, { "creatorType": "author", "firstName": "Lucien JLPG", "lastName": "Engelen" }, { "creatorType": "author", "firstName": "Sivera AA", "lastName": "Berben" }, { "creatorType": "author", "firstName": "Lisette", "lastName": "Schoonhoven" } ], "abstractNote": "", "publicationTitle": "Journal of Medical Internet Research", "publisher": "", "place": "", "date": "06/2010", "volume": "12", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Med Internet Res", "DOI": "10.2196/jmir.1350", "citationKey": "", "url": "http://www.jmir.org/2010/2/e18/", "accessDate": "2010-08-19T00:45:37Z", "PMID": "", "PMCID": "", "ISSN": "1438-8871", "archive": "", "archiveLocation": "", "shortTitle": "Definition of Health 2.0 and Medicine 2.0", "language": "", "libraryCatalog": "CrossRef", "callNumber": "0000", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2010-08-19T00:45:37Z", "dateModified": "2010-08-19T00:45:38Z" } } ]