Evidence of decision support benefits lacking, researchers say

Healthcare technology continues to come under fire for failing to deliver results--whether lower costs, increased efficiency, better clinical outcomes. This time researchers are turning their critical eye to clinical decision support.

Despite increasing emphasis on the role of clinical decision-support systems for improving care and reducing costs, evidence to support widespread use is lacking, they conclude in a systematic review of 148 randomized, controlled trials. The study was funded by the Agency for Healthcare Research and Quality and published yesterday in the Annals of Internal Medicine.

Researchers looked at several potential benefits of decision support, including better clinical outcomes, improvements to workload and efficiency, increased patient satisfaction and reduced cost. The study also looked at provider use and implementation.

"Both commercially and locally developed CDSSs are effective at improving healthcare process measures across diverse settings, but evidence for clinical, economic, workload and efficiency outcomes remains sparse," the researchers concluded. "Our findings are important in light of the increasing political interest and financial investment of the U.S. government in resources for health IT."

The argument--which, to be clear, is not that healthcare technology doesn't offer these benefits but that it is not proven to offer them--is a recurring one. And a number of recent studies have questioned the benefits of health IT.

Earlier this year, the Journal of the American Medical Informatics Association published a series of studies on health technology, including one that found some electronic health records are lacking in adverse drug event detection.

A study published earlier this month by researchers at the Mayo Clinic and Purdue University found that remote monitoring doesn't prevent readmissions among older patients with multiple health issues.

A study published in March found electronic access to medical imaging and lab results has led to a significant increase in imaging and blood tests--researchers dubbed this the "convenience effect."

The latter led to a war of written words between the authors of the study and Farzad Mostashari, the National Coordinator for Health IT, who argued the study "ultimately tells us little about little about the ability of electronic health records to reduce costs" and "nothing about the impact of EHRs on improving care."

To learn more:
- read the full Annals of Internal Medicine study

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