IntroductionOver 80% of people with diabetes have co-morbidities, which increase in number with age. Evidence-based guidelines for these conditions are developed on a disease-specific basis, resulting in multiple guidelines. Approximately half of Healthcare Professional (HCP) clinical decisions fail to take account of the best available evidence. Clinical decision support systems (CDSS) within an electronic health record (EHR) can improve HCP performance by providing automated, tailored, evidence-based advice. This project aims to implement and evaluate the Evidence Based Medicine electronic Decision Support (EBMeDS) system within a national EHR for diabetes.MethodsEBMeDS algorithms were developed with reference to national clinical guidelines and implemented within Scotland’s EHR for diabetes, SCI-Diabetes. A cyclical, quality improvement approach was used to adapt the system in light of user feedback. Evaluation used a mixed methods approach involving: HCP & patient questionnaires; focus groups; system navigational data; and case control comparisons of clinical processes & outcomes.Results19 EBMeDS scripts aimed at screening for complications and treatment optimisation were developed. Improvement cycle 1 ran from Dec 13-Feb 14 involving a tertiary centre diabetes clinic (~500 patients/month). The system was adapted prior to cycle 2 that involved primary and secondary care within a defined geographical area (pop. 412,160, number of people with diabetes 22,033).17,280 patient EHRs were opened during cycle 1, 6665 (39%) of which triggered an EBMeDS message. The median number of messages was 3 (IQ range 2-5). The presence of a message was associated with a significant reduction in duration that the EHR was viewed: median duration 40 sec (IQ range 13-93) vs 32 sec (IQ range 7-84), p<0.001.User feedback was favourable with individuals reporting more efficient clinical practices. Patient and HCP feedback did not identify any adverse effects on the consultation. Users requested that messages are tailored to context and role.DiscussionThis service improvement project highlights the benefits of an iterative approach that adapts to users’ needs. The system has been well received and has the potential to improve efficiency in decision making with no reported adverse effects. Evaluation of clinical processes and outcomes is ongoing. Ultimately, the system has the potential to incorporate any number of relevant guidelines whilst tailoring messages to user role and clinical context.