Evaluation studies of clinical decision support systems (CDSS) have tended to focus on assessment of system quality and clinical performance in a laboratory setting. Relatively few studies have used field trials to determine if CDSSs are likely to be used in routine clinical settings and whether reminders generated are likely to be evaluated by end-users. This paper argues that such beneficial outcomes are not likely to occur if use of the system results in side-effects such as decreased end-user efficiency and unanticipated changes in normal workflows.
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