Clinical Decision Support and Rich Clinical Repositories: A Symbiotic Relationship: Comment on “Electronic Health Records and Clinical Decision Support Systems”

In this issue of the Archives, Romano and Stafford report on the effect of electronic health records (EHRs)—both with and without clinical decision support (CDS)—on physician adherence to evidence-based guidelines. They used data from the National Ambulatory Medical Care Survey¹ (NAMCS) and the National Hospital Ambulatory Medical Care Survey² (NHAMCS) to evaluate physician performance on 20 quality indicators. The results that Romano and Stafford found were dismal. The investigators observed no consistent difference in guideline adherence among providers who used paper medical records compared with those who used either an EHR alone or an EHR with CDS.