CC BY-NC-ND 4.0 · Yearb Med Inform 2023; 32(01): 169-178
DOI: 10.1055/s-0043-1768722
Section 6: Decision Support

The Impact of Clinical Decision Support on Health Disparities and the Digital Divide

Brian J. Douthit
1   Post-Doctoral Research Fellow: United States Department of Veterans Affairs, Vanderbilt University, Nashville, TN, USA
Allison B. McCoy
2   Assistant Professor: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
3   Director: Clinical Informatics Core, Vanderbilt University Medical Center, Nashville, TN, USA
Scott D. Nelson
4   Associate Professor: Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
5   Program Director: MS in Applied Clinical Informatics Program (MS-ACI), Vanderbilt University, Nashville, TN, USA
6   Clinical Director: HealthIT, Vanderbilt University Medical Center, Nashville, TN, USA
› Author Affiliations


Objectives: This literature review summarizes relevant studies from the last three years (2020-2022) related to clinical decision support (CDS) and CDS impact on health disparities and the digital divide. This survey identifies current trends and synthesizes evidence-based recommendations and considerations for future development and implementation of CDS tools.

Methods: We conducted a search in PubMed for literature published between 2020 and 2022. Our search strategy was constructed as a combination of the MEDLINE®/PubMed® Health Disparities and Minority Health Search Strategy and relevant CDS MeSH terms and phrases. We then extracted relevant data from the studies, including priority population when applicable, domain of influence on the disparity being addressed, and the type of CDS being used. We also made note of when a study discussed the digital divide in some capacity and organized the comments into general themes through group discussion.

Results: Our search yielded 520 studies, with 45 included at the conclusion of screening. The most frequent CDS type in this review was point-of-care alerts/reminders (33.3%). Health Care System was the most frequent domain of influence (71.1%), and Blacks/African Americans were the most frequently included priority population (42.2%). Throughout the literature, we found four general themes related to the technology divide: inaccessibility of technology, access to care, trust of technology, and technology literacy.

This survey revealed the diversity of CDS being used to address health disparities and several barriers which may make CDS less effective or potentially harmful to certain populations. Regular examinations of literature that feature CDS and address health disparities can help to reveal new strategies and patterns for improving healthcare.

Supplementary Material

Supplementary Material

Publication History

Article published online:
06 July 2023

© 2023. IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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