​Providers reported strong satisfaction with clinical decision support (CDS) systems used during patient visits, but both providers and patients expressed frustration that using CDS took the provider's attention away from the patient, according to a study published June 2, 2017, in BMC Medical Informatics and Decision Making. In the study, 34 general practitioners each met with six standardized patients using only an electronic health record (EHR) system, and with another six similar standardized patients using EHRs enhanced with CDS. Providers consistently reported that CDS was helpful in prompting them to consider more diagnoses and ask more targeted questions; nearly three-quarters (74%) of participating physicians stated that the CDS was useful. The providers particularly appreciated that the CDS included a checklist of symptoms to consider with each suggested diagnosis. However, half of the physicians were concerned that using the CDS forced them to change their consultation style because of the required interaction with the computer. Although patient satisfaction scores did not differ significantly between the two types of visits, patients whose visits included CDS use were more likely to comment that providers were looking more at the computer than at the patient. The attention needed to code symptoms and diagnoses when using CDS presents an important barrier to adoption, the authors conclude, requiring interface improvements to limit distractions and allow providers to focus on patients.

HRC Recommends: When implemented effectively, CDS can benefit patient safety. If such a system is implemented without properly assessing its role in the diagnostic process, however, it may act as a hindrance rather than a help, resulting in the use of workarounds and increasing the risk that patient care steps will be missed. Likewise, overuse of CDS systems can lead to alert fatigue and missed information, while underuse can lead to other patient safety issues. Planning to implement any health information technology system should include input from staff members who will be using the system and an assessment of current workflows, to ensure the smooth integration of the new system.