Computer-based guideline implementation systems: A systematic review of functionality and effectiveness

, this systematic review, the authors analyze the functionality provided by recent computer-based guideline implementation systems and characterize th e effectiveness of the systems. Twenty-five studies published between 1992 and January 1998 were identified. Articles were included if the authors ind icated an intent to implement guideline recommendations for clinicians and if the effectiveness of the system was evaluated. Provision of eight inform ation management services and effects on guideline adherence, documentation , user satisfaction, and patient outcome were noted. All systems provided patient-specific recommendations. In 19, recommendatio ns were available concurrently with care. Explanation services were describ ed for nine systems. Nine systems allowed interactive documentation, and 17 produced paper-based output. Communication services were present most ofte n in systems integrated with electronic medical records. Registration, calc ulation, and aggregation services were infrequently reported. There were 10 controlled trials (9 randomized) and 10 time-series correlational studies. Guideline adherence improved in 14 of 18 systems in which it was measured. Documentation improved in 4 of 4 studies.