widespread adoption of health information technology through the Health Information Technology for Economic and Clinical Health Act (HITECH). Through these initiatives, more hospitals and clinics are integrating electronic medical records (EMRs) and computerized physician order entry (CPOE) within their health information processing and storage. Consequently, the Institute of Medicine (IOM) promoted the usage of health information technology, including clinical decision support systems, to advance the quality of patient care. The IOM had published a report in 1999, To Err is Human, which focused on the patient safety crisis in the United States, pointing to the incredibly high number of deaths. This statistic attracted great attention to the quality of patient care. With the enactment of the HITECH Act included in the ARRA, encouraging the adoption of health IT, more detailed case laws for CDSS and EMRs are still being defined by the Office of National Coordinator for Health Information Technology (ONC) and approved by Department of Health and Human Services (HHS). A definition of "Meaningful use" is yet to be published. Despite the absence of laws, the CDSS vendors would almost certainly be viewed as having a legal duty of care to both the patients who may adversely be affected due to CDSS usage and the clinicians who may use the technology for patient care. However, duties of care legal regulations are not explicitly defined yet. With recent effective legislations related to performance shift payment incentives, CDSS are becoming more attractive. Effectiveness The evidence of the effectiveness of CDSS is mixed. There are certain diseases which benefit more from CDSS than other disease entities. A 2018 systematic review identified six medical conditions in which CDSS improved patient outcomes in hospital settings, including blood glucose management, blood transfusion management, physiologic deterioration prevention, pressure ulcer prevention, acute kidney injury prevention, and venous thromboembolism prophylaxis. A 2014 systematic review did not find a benefit in terms of risk of death when the CDSS was combined with the electronic health record. There may be some benefits, however, in terms of other outcomes. A 2005 systematic review had concluded that CDSSs improved practitioner performance in 64% of the studies and patient outcomes in 13% of the studies. CDSSs features associated with improved practitioner performance included automatic electronic prompts rather than requiring user activation of the system. A 2005 systematic review found... "Decision support systems significantly improved clinical practice in 68% of trials." The CDSS features