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First published August 4, 2003 as JAMIA PrePrint; doi:10.1197/jamia.M1370
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J Am Med Inform Assoc. 2003;10:523-530. DOI 10.1197/jamia.M1370.
© 2003 American Medical Informatics Association

Synthesis of Research Paper

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality

David W. Bates, MD, MSc, Gilad J. Kuperman, MD, PhD, Samuel Wang, MD, PhD, Tejal Gandhi, MD, MPH, Anne Kittler, BA, Lynn Volk, MHS, Cynthia Spurr, RN, MBA, Ramin Khorasani, MD, Milenko Tanasijevic, MD and Blackford Middleton, MD, MSc, MPH

Affiliations of the authors: Division of General Medicine, Department of Medicine (DWB, GJK, TG, BM), Department of Radiology (RK), and Department of Pathology (MT), Brigham and Women's Hospital; and Partners HealthCare Information Systems, Clinical and Quality Analysis (DWB, AK, LV) and Clinical Informatics Research and Development (GJK, SW, CS, BM), Partners Healthcare Systems and Harvard Medical School, Boston, Massachusetts.

Correspondence and reprints: David W. Bates, MD, MSc, Division of General Medicine and Primary Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail: <dbates{at}partners.org>.

Received for publication: 03/25/03; accepted for publication: 05/27/03.

While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. Furthermore, providers make many errors, and clinical decision support can be useful for finding and preventing such errors. Over the last eight years the authors have implemented and studied the impact of decision support across a broad array of domains and have found a number of common elements important to success. The goal of this report is to discuss these lessons learned in the interest of informing the efforts of others working to make the practice of evidence-based medicine a reality.




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