Economic Impact of Clinical Decision Support Interventions Based on Electronic Health Records


Unnecessary healthcare utilization, non-adherence to current clinical guidelines or insufficient personalized care are perpetual challenges and remain potential major cost-drivers for healthcare systems around the world. Implementing decision support systems into clinical care is promised to increase quality of care and thereby yield substantial effects onreducing healthcare expenditure. Inthis articleweevaluate the economic impact of clinical decision support (CDS) interventions which are based on electronic health records (EHR).


We searched for studies published after 2014 using MEDLINE, CENTRAL, WEB OF SCIENCE, EBSCO, and TUFTS CEA registrydatabases that encompass an economic evaluation or consider cost outcome measures of EHR based CDS interventions. Thereupon, we identified best practiceapplication areas and categorized the investigated interventions according to an existing taxonomy of front-endCDS tools.

Results and discussion

Twenty-sevenstudies are investigated in this review. Of those, twenty-twostudies indicate a reduction of healthcare expenditure after implementingan EHRbased CDS system, especiallytowardsprevalent application areas, such as unnecessarylaboratory testing, duplicate order entry, efficient transfusion practice or reduction of antibiotic prescriptions.On the contrary, order facilitators and undiscovered malfunctions revealed to be threats and could lead to new cost drivers in healthcare. While high upfront and maintenance cost of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost. Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance for further high quality economic evaluations for these CDS systems.


Current research studies lack to consider comparative cost-outcome metrics as well as detailed cost-components in their analyses. Nonetheless, thepositive economic impact of EHR based CDS interventions especially with regard to reducing waste in healthcare is highly promising.

Linkki alkuperäisjulkaisuun

Download PDF

Economic Impact of Clinical Decision Support - Interventions Based on Electronic Health Records