Clinical decision support systems

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This is a review of Beeler, P.E., Bates, D.W. & Hug, B.L. (2014). “Clinical decision support systems”. [1]


Clinical Decision Support (CDS) has been shown to help reduce the occurrence of Deep Vein Thrombosis (DVT), promote the use of vaccinations and decrease serious and costly medication errors. Beeler, Bates & Hug, (2014) point out that “CDS may introduce errors, and therefore the term “e-iatrogenesis” has been proposed to address unintended consequences” (p.1). Keeping in mind the benefits and pitfalls associated with CDS, its implementation must be cautiously carried out.


This was a review article so Beeler, Bates & Hug, (2014) looked at such topics as basic duties and types of CDS, the expected consequences of CDS which are “expected to lead to higher patient safety with better treatment quality, less adverse events and reduced costs” (p.2). Another area examined was the potential for CDS to do harm such as do “false positive alerts increase the risk of alert fatigue” (p.3). Finally the authors dealt with the implementation of CDS and likely future research avenues.


Through their research Beeler, Bates & Hug, (2014) found numerous positive outcomes associated with CDS such as “higher patient safety with better treatment quality, less adverse events and reduced costs” (p.2). Also of particular interest the authors found in the literature reviewed that when CPOE is coupled with CDS the frequency of adverse drug events are lowered considerably. Of course there were references in this work to some cons of CDS mostly citing excessive alerts as well as extra duties and time spent without any direct face to face time with their patients. Various strategies have been proposed to reduce user "Alert Fatigue", please see examples such as Drug–drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records and Characteristics and consequences of drug-allergy alert overrides


Beeler, Bates & Hug, (2014) puts forth some very strong arguments in support of CDS systems as well as their combination with CPOE. This paper has a very extensive reference section which endows the study with many important points on CDS pros, cons, its implementation and future research. The authors emphasize the importance of the implementation of the CDS as critical to its overall degree of usability and potential to mitigate possible medical mishaps.

Another important aspect of successful CDS implementation is clinician acceptance. A paper investigating this was done by Sittig, D.F., Krall, M.A., Dykstra, R.H., Russell, A. and Chin, H.L. (2006) and was titled “A survey of factors affecting clinician acceptance of clinical decision support”.

Related articles

1. A 2014 medical informatics perspective on clinical decision support systems: do we hit the ceiling of effectiveness

2. Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research


  1. Beeler, P.E., Bates, D.W. & Hug, B.L. (2014). Clinical decision support systems. Swiss Medical Weekly; 144:w14073.