Commentary

CDSSs facilitate the integration of health related information for individuals with an underlying knowledge base so that patient specific recommendations can be provided to healthcare practitioners to assist with their decision making. These systems are beneficial when used to facilitate preventive healthcare delivery and to assist with the dosing of medications with narrow therapeutic windows.¹ The potential for these systems to improve outcomes in other aspects of health care, however, remains unclear: some studies have shown a benefit while others have not.

The study by Montgomery et al is an important contribution to this area. The trial was well designed and included clinically important end points. The study also included a non-computer based decision aid that was used by itself in 1 of the study groups. The results, including the finding that the CDSS did not lead to improved cardiovascular risk profiles or blood pressure control and that a simple cardiovascular risk chart used alone led to an improvement in systolic blood pressure, have implications for both clinical practice and future research on CDSSs. For clinicians, it is clear that CDSSs designed to assist with the management of complex medical conditions still require additional development and evaluation before being introduced into routine clinical practice. Inexpensive, non-computer based approaches that can be easily integrated into a clinic should also be considered. For researchers, increasing efforts should now focus on identifying those factors that predict whether a CDSS will have a clinically important effect when introduced into clinical practice.