Adoption of Clinical Decision support in Multimorbidity: A Systematic Review

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This is a review of a systematic review that evaluates the use of CDS in multimorbidity conditions by Fraccaro et al., (Jan, 2015), titled 'Adoption of Clinical Decision Support in Multimorbidity: A systematic Review'. [1]


According to Fraccaro et al (2015), the rise in the number of aging population [1] is associated with multiple clinical conditions per patient or known as multiplemorbidity. Even worse, multimorbidity is complex and demanding in nature. To illustrate the complexity, Fraccaro et al (2015) listed some of the potential problems associated with it as follows:

• Interaction between pathologies, • Duplication of tests, • Difficulties in adhering to often conflicting clinical practice guidelines, • Obstacles in continuity of care, confusing self-management information and • Medication errors


The objective of the literature is to assess the extent of CDS adoption in the area of multimorbidity.


For this literature reviewers searched databases such as Scopus and PubMed by combining terms and synonyms, including: multimorbidity and comorbidity, polypharmacy and CDS. Relevant articles for the review were further analyzed. The most frequent diseases mentioned were cardiovascular and diabetes.[1]


Out of the 50 articles that were selected for final review only 20 studies were included in the article. None of the articles reviewed adopted mobile technologies. [2]


The review asserts that CDS is not fully invested in the area of multimorbidity. It also warns, CDS intervention that doesn’t consider the interaction of different clinical conditions within a patient may even result in harm than benefit. However, on the brighter side, data needed to build such complex CDS is available in the current EMRs.


Finally Fraccaro et al (2015) concludes, “ multimorbildity is understudied in CDS, yet this is an area of public health and clinical importance that should be a prime target for CDS research”


The limitations of the review are as follows: • Only two databases were searched, • Potentially useful articles may have been missed based on the terms and synonyms used during the search, • Reviewers were unable to find articles that covers all aspects of CDS, • Reviewers didn’t strictly follow the traditional systematic review.


This review touched an area that is not fully addressed by CDS. Now, it is important to note the need for a refined CDS system that has a capacity to deal with complex multimorbidity conditions that is becoming prevalent as a result of an increasing number of aging populations.


  1. 1.0 1.1 Fraccaro, P., Casteleiro, M., Ainsworth, J., Buchan, I.Adoption of Clinical Decision Support in Multimorbidity: A systematic Review. JMIR Med Inform 2015;3(1):e4   doi:10.2196/medinform.3503. Retrived from
  2. Mobile Health Implementation.