Clinical Decision Support Systems (CDSSs): State of the art Review of Literature

Amir Mohammad Shahsavarani, Esfandiar Azad Marz Abadi, Maryam Hakimi Kalkhoran, Saeideh Jafari, Shirin Qaranli


Introduction: One of the major advances in medical practice and healthcare is to incorporate decision support systems (DSS) in such practices to assist healthcare staff. The present study aimed to make a general understanding framework about state of the art clinical decision support systems (CDSS).

Methods: The design was systematic review. According to Research keywords (decision, decision-making, clinical decision, clinical decision-making, decision support, decision support system, clinical decision support system), Persian and English papers and scientific literature in scientific data bases include Simorgh, MagIran, and SID for Persian, as well as Science Direct, Google Scholar, Google Patent, Wikipedia, PubMed, Sage, and Springer for English resources were searched, so that from a basic sample of 1247 papers, 27 papers were selected regarding inclusion criteria. Delphi method was implemented to construct the final format of results report. The method of data analysis were librarian and content analysis.

Results: Two main definitions of CDSS, 13 popular CDSSs, major aims of usage, practical and theoretical benefits, principal methods of decision support, three major classifications, medical/clinical data mining, EBM, and efficacy of CDSS have been evaluated and discussed.

Conclusion: The usage of CDSS in clinical and healthcare settings is increasing. It has been shown that incorporation of CDSS can significantly improve health outcome indices. However, authorities shall establish standards and quality control systems to evaluate and integrate development and implementation procedures of CDSS. In addition, future studies would better head-to-head compare alike CDSS to evaluate competitive advantages and concurrent validity of various CDSSs. 



Decision Support Systems (DSS), Clinical Decision Support Systems (CDSS), Multiple-criteria Decision Analysis (MCDA), Multiple-criteria Decision Making (MCDM), Medical/Clinical Data Mining, Evidence-Based medicine (EBM), Systematic Review, Delph

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Bonatti E, Kuchukhidze G, Zamarian L. Decision making in ambiguous and risky situations after unilateral temporal lobe epilepsy surgery. Epilepsy & Behavior. 2009; 14: 665-73.

Adams A, Vail L, Buckingham CD, Kidd J, Weich S, Roter D. Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression. Social Science & Medicine. 2014; 116(0): 161-8.

Khalesi Zadeh SM, Kachouei R. Designing decision support system as an effective instrument of management in production units. Sharif Scientific and Research Quarterly. 2006; 36:75-79 [Persian].

Boukhanovsky A, Bubak M. High Performance Computations for Decision Support in Critical Situations: Introduction to the Third Workshop on Urgent Computing. Procedia Computer Science. 2014; 29(0): 1644-5.

Agharezaei Z, Tofighi S, Nemati A, Agharezaei L, Bahaadinbeigi K. Surveying Kerman’s Afazalipour Hospital clinical and educational staff`s points of view about the clinical decision support system designed for reducing the possibility of pulmonary embolism and deep vein thrombosis. Hospital Quarterly. 2013; 12(2): 29-38 [Persian].

Parshutin S, Kirshners A. Research on clinical decision support systems development for atrophic gastritis screening. Expert Systems with Applications. 2013; 40(15): 6041-46.

Nelson KE., Mahant, S. (2014). Shared Decision-Making About Assistive Technology for the Child with Severe Neurologic Impairment. Pediatric Clinics of North America, 61(4), 641-652.

Marcos M, Maldonado JA, Martínez-Salvador B, Boscá D, Robles M. Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility. Journal of Biomedical Informatics. 2013; 46(4): 676-89.

Hersh WR. Medical informatics: Improving Health care through Information. JAMA. 2002; 288(16): 1955-8.

Hagen-Zanker J, Duvendack M, Mallett R, Slater R, Carpenter S, Tromme M. Making systematic reviews work for international development research. London, UK: Secure Livelihood Research Consortium (SLRC); 2012.

Greenhalgh T, Potts HWW, Wong G, Bark P, Swinglehurst D. Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method. Milbank Quarterly. 2009; 87(4), 729–88.

Donohoe HM, Needham RD. Moving best practice forward: Delphi characteristics, advantages, potential problems, and solutions. International Journal of Tourism Research. 2009; 11(5): 415–37.

von Bergner NM, Lohmann M. Future challenges for global tourism: A Delphi survey. Journal of Travel Research. 2014; 53(4): 420–32.

Green KC, Armstrong J, Graefe A. Methods to Elicit Forecasts from Groups: Delphi and Prediction Markets Compared. Forthcoming in Foresight. The International Journal of Applied Forecasting. 2007; 4999(23), 1-7.

Hsu CC, Sandford, BA. Delphi technique. In NJ Salkind, Editor. Encyclopedia of Research Design. Thousand Oaks, CA, USA: Sage Publications. 2010; pp. 344–7.

Konu, H. Developing nature-based tourism products with customers by utilizing the Delphi method. Tourism Management Perspectives. 2015; 14:42-54.

Hanafin S. Review of literature on the Delphi technique. Dublin, Ireland: Department of Children and Youth Affairs. 2004, p. 5.

Pombo N, Araújo P, Viana J. (2014). Knowledge discovery in clinical decision support systems for pain management: A systematic review. Artificial Intelligence in Medicine, 60(1), 1-11.

Asadabadi RG, Amerian A, Tofighi S, Azizian F, Fayazi A. Designing the decision support Information system model for board of trustees in Ayatollah Kashani Hospital, Shahrekord. Health Information management. 2012; 9(4): 479-89 [Persian].

Abdi M. Review management information system, Department of Budget and plan Baqiyatallah University of Medical Sciences (BMSU) and presented its architecture based methodology (Rational Unified Process) RUP in 2008 [MSc Thesis]. Tehran, Iran: Faculty of Health, Baqiyatallah University of Medical Sciences; 2009 [Persian].

Safdari R, Karami M, Mirzaee M, Rahimi A. A systematic review of decision support systems: Effects on health care. Journal of faculty of Paramedicine of Medical University of Tehran (Peyavard Salamat). 2013; 7(1): 56-70.

Alidousti S. Value assessment in rationalization of decision-support systems. Librarianship and Information Science; 10(2): 309-36 [Persian].

Mulliner E., Smallbone K, Maliene V. (2013). An assessment of sustainable housing affordability using a multiple criteria decision making method. Omega, 41(2), 270-279.

Maliene V. Specialised property valuation: Multiple criteria decision analysis. Journal of Retail Leisure Property. 2011; 9(5): 443-50.

Yue Z. TOPSIS-based group decision-making methodology in intuitionistic fuzzy setting. Information Sciences. 2014; 277(0), 141-53.

Sun B, Ma W, Zhao H. Decision-theoretic rough fuzzy set model and application. Information Sciences. 2014; 283(0), 180-96.

Malakooti B. Operations and Production Systems with Multiple Objectives. New York, NY, USA: John Wiley & Sons; 2013.

Triantaphyllou E. Multi-Criteria Decision Making: A Comparative Study. Dordrecht, Netherlands: Springer; 2010.

Greens RA. Clinical Decision Support: The Road to Broad Adoption (2nd ed.). Waltham, MA, USA: Academic Press; 2014.

Fraccaro P, O’Sullivan D, Plastiras P, O’Sullivan H, Dentone C, Di Biago A, Weller P. Behind the screens: Clinical decision support methodologies – A review. Health Policy and Technology. 2014; (Article in press):

Qazanfari M, Alizadeh S, Teimour-pour B. Data mining and knowledge exploration. Tehran, Iran: University of Science and Industry Press; 2014 [Persian].

Kohavi RA. Study of cross-validation and bootstrap for accuracy estimation and model selection. In Proceedings of the 14th International Conference on AI (IJCAI), San Mateo, CA, USA: Morgan Kaufmann; 1995. pp. 1137–45.

Ahmad LQ. A review of seven superior algorithms of data mining in prediction of survival, diagnosis, and relapse in patients with mammary cancer. Quarterly of Mammary disease of Iran. 2013; 6(1): 52-61 [Persian].

Rodrigues RJ. Information systems: the key to evidence-based health practice. Bulletin of World Health Organization. 2000; 78(11): 1344-51.

Sackett DL, Rosenberg WMC, Richardson WS, Hynes RB, Muir Gray JA. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996; 312(1): 71-2.

Soltani A. Evidence based medicine. 2nd ed. Tehran, Iran: Vista; 2008. pp. 3-15 [Persian].

Zarinara AR. What is evidence based medicine? Homaye Salamat Journal. 2008; 4(3): 71-4 [Persian].

Firooz AR, Khatami AR. A review on evidence-based medicine. Iranian Journal of Dermatology. 2004; 7(2): 101-11 [Persian].

Claridge JA, Fabian TC. History and development of evidence- based medicine. World Journal of Surgery. 2005; 29(5): 547-53.

Sackett DL, Rosenberg WM. The need for evidence- based medicine. J R Soc Med 1995; 88(11): 620-4.

Rangrajeddi F, Moraveji A, Abazari F. Capability to establish evidence-based medicine by hospital information system. Journal of faculty of Paramedicine of Medical University of Tehran (Peyavard Salamat). 2013; 7(6): 512-22 [Persian].

Mueller ML, Ganslandt T, Frankewitsch T, Krieglstein CF, Senninger N, Prokosch HU. Workflow analysis and evidence- based medicine: towards integration of knowledge-based functions in hospital information systems. Proc AMIA Symp. 1999; 1(1): 330-4.

Cheung, A, van Velden FHP, Lagerburg V. The organizational and clinical impact of integrating bedside equipment to an information system: A systematic literature review of patient data management systems (PDMS). International Journal of Medical Informatics. 2015; 84: 155-65.

Omididan Z, Hadianfar, AM. The role of clinical decision support systems in healthcare (1980-2010): A systematic review study. Jentashapir Sceintific-Research Quarterly. 2011; 2(3): 125-34 [Persian].

Kaushal R, Kern LM, Barrón Y, Quaresimo J, Abramson EL. Electronic prescribing improves medication safety in community-based Office Practices. Journal of General Internal Medicine. 2010; 25(6): 530-36.

Dowding D, Randell R, Gardner P, Fitzpatrick G, Dykes P, Favela J, et al. Dashboards for improving patient care: Review of literature. International Journal of Medical Informatics. 2015; 84: 87-100.


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