The road to effective clinical decision support: are we there yet?

Have we arrived at an understanding of what factors make clinical decision support effective? The short answer is “no.” In fact, our knowledge of this field may have taken a step backwards.

Reams of new scientific evidence are published each year, and it is increasingly difficult for practitioners to integrate this tsunami of best practice information into routine care.1 The use of electronic health records, particularly those with integrated decision support—tools through which patient specific information is intelligently processed to provide patient specific guidance—is touted as a means of promoting evidence based care.2 3 Ironically, however, evidence on what constitutes effective decision support is sorely lacking.

In a linked paper (doi:10.1136/bmj.f657), Roshanov and colleagues report a regression analysis of data abstracted from 162 randomized controlled trials. The analysis aims to identify which factors enable effective decision support.4 Most studies to date have sought simply to determine whether or not decision support tools could modify clinical process …