Table 2 Quality assessment of the CDSSs
References | CDSS design | Data entry source | Implementation characteristic | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Is it integrated with CPOE? | Does it give real time feedback at point of care? | Does the CDS suggest a recommended course of action? | CDSS Classification* | Is it automated through EHR? | Does clinical staff enter data specifically for intervention? | Was it pilot tested or used an iterative process of development/ implementation? | Was there any user training/clinician education? | Are the authors also the developers and part of the user group for the CDS? | Was there use of audit and- feedback (or other internal incentive)? | Are there any other implementation components not already discussed? | |
Bates et al. [28] | Yes | Yes | No | C | Yes | No | NM** | NM | Yes | No | 50% of the tests with a computer order were not screened for redundancy because they were ordered as part of an order set |
BoonFalleur et al. [31] | No | No | No | B | No | No | Yes | NM | NM | No | No |
Bridges et al. [34] | Yes | Yes | No | B | NM | No | Yes | NM | No | No | Clinicians likely experienced an “adjustment” period once they became familiar with the alert, |
Dalal et al. [35] | Yes | Yes | No | D | Yes | No | Yes | Yes | Yes | No | No |
Eaton et al. [36] | Yes | Yes | No | B | No | NM | No | NM | NM | No | No |
Gottheil et al. [30] | Yes | Yes | No | C | NM | No | Yes | NM | Yes | Yes | The importance of stakeholder engagement prior to the intervention and having decision leaders in each department to champion our cause |
Klatte et al. [37] | Yes | Yes | No | D | Yes | Yes | Yes | NM | NM | No | No |
Levick et al. [38] | Yes | Yes | No | B | No | No | NM | NM | Yes | No | Use of alerts should be used judiciously and in the appropriate environment |
Lippi et al. [32] | Yes | Yes | No | B | NM | No | NM | NM | Yes | Yes | No |
Nicholson et al. [39] | Yes | Yes | No | C | NM | Yes | NM | NM | Yes | No | No |
Niès et al. [33] | Yes | Yes | No | C | Yes | No | Yes | NM | Yes | No | Testing options were constrained by unbundling serum metabolic panel tests into single components and reducing the ease of repeating targeted tests |
Quan et al. [40] | Yes | Yes | No | D | NM | No | NM | NM | NM | Yes | No |
Procop et al. [41] | Yes | Yes | No | D | NM | No | Yes | Yes | No | Yes | No |
Rosenbloom et al. [42] | Yes | Yes | No | C | NM | Yes | NM | NM | Yes | Yes | Designers of CDS interventions should take into account the paradoxical prompting that such interventions might generate |
Rudolf et al. [43] | Yes | Yes | No | C | NM | Yes | NM | NM | NM | Yes | Providers could use workarounds to place daily orders, entering the orders in a manner that would not trigger the audits. For example, placing staggered sets of orders to occur every other day or writing in daily orders on templates could have circumvented our auditing process and accounting of daily testing for this analysis |
Samuelson et al. [44] | Yes | Yes | No | C | NM | Yes | NM | NM | NM | NM | No |
Sum | |||||||||||
Yes No NM | 15 1 0 | 15 1 0 | 0 16 0 | A: 0 B: 5 C: 7 D: 4 | 4 3 9 | 5 10 1 | 8 1 7 | 2 0 14 | 8 2 6 | 6 9 1 | |