Trends in the Use of Clinical Decision Support by Health System–Affiliated Ambulatory Clinics in the United States, 2014–2016

Published in: The American Journal of Accountable Care, Volume 7, Number 4, pages 4–10 (December 2019)

Posted on on August 25, 2020

by Robert S. Rudin, Shira H. Fischer, Yunfeng Shi, Paul G. Shekelle, Alejandro Amill-Rosario, M. Susan Ridgely, Dennis P. Scanlon, Cheryl L. Damberg

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.


Clinical decision support (CDS) is important for delivering high-quality care. We examined the use of 7 functions of CDS and changes over time in US health system–affiliated ambulatory clinics.

Study Design

We analyzed longitudinal data for 19,209 ambulatory clinics that participated in 3 years (2014–2016) of the Healthcare Information and Management Systems Society Analytics survey to assess use of 7 CDS functions and the characteristics of clinics associated with use of CDS.


We used descriptive statistics and linear probability models to assess the association of clinic characteristics (practice type, health system type, practice size) and 2 outcomes: CDS use during the study period and CDS use beginning in 2015 or 2016.


Use rates increased between 2014 and 2016 for all 7 CDS functions, with increases ranging from 4 percentage points (genetic testing) to 13 percentage points (diagnostic result alerts). In 2016, the rate of use was highest for basic medication screening (61%), clinical guidelines and protocols (54%), and preventive medicine (57%). Lower use rates were observed for diagnostic result alerts (42%), remote device alerts (19%), incorporation of community-based electronic health record data into rules engines (26%), and genomics profiling in orders (9%). More than half of health systems, which included many smaller health systems, reported that none of their affiliated clinics used any CDS function. Affiliation with a multihospital health system and clinic size, but not clinic type (eg, primary care), were associated with a greater likelihood of use for most CDS functions.


Despite federal investment to promote health information technology adoption, substantial gaps remain in the use of CDS among ambulatory clinics, particularly among smaller health systems.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.