Table 2 Summary of key findings from qualitative and quantitative evidence

Perceived duration (mainly qualitative studies) n = 72

Perceived increase in duration (n = 36) [15, 16, 27, 28, 30,31,32, 34,35,36,37, 41, 44, 47, 50, 53, 61, 71, 77, 78, 83, 89, 92, 93, 96, 97, 101, 102, 104, 107, 110, 112, 115, 117, 124]

Existing time/workload pressures [16, 27, 28, 30, 31, 36, 41, 44, 47, 50, 71, 77, 78, 89, 93, 96, 97, 101, 104, 107, 110, 112, 115, 117, 124, 131]; eCDS tools will add burden [92, 104]

No time for preventive care [32]

Workflow disruption [30, 83, 93, 102, 104]; interruptive alerts/functions [117]

Slow software [35, 37, 61]; being a separate system to EMR [16, 34, 71]

Change to the trajectory of conversation with patient [15, 53, 104]

Increased consultation duration might be ‘acceptable’ in some cases

Perceived decrease in duration (n = 6) [62, 67, 67, 131]

eCDS tools that were seen to improve efficiency [62, 69, 81]

Tools designed to support patient management (rather than diagnosis) [69, 81, 98, 118]

Tools that were embedded in the EMR [62, 81, 118]

Reduced need for data entry [81, 98]

Fitting with usual workflow [118]

Perception of no impact on duration (n = 4) [42, 63, 114, 127]

No obvious explanatory factors highlighted

Low number of instances where a cardiovascular (CV) risk eCDS tool indicated high risk [63]

Tools that guide the whole consultation and that were non-interruptive [42, 108, 127]

Objectively-measured duration (mainly quantitative studies) n = 26

 Increased duration (n = 3) [38, 54, 117]

An eCDS tool which took longer than the length of a typical consultation [54]

 Decreased duration (n = 4) [116, 120,121,122]

eCDS tools that helped speed up certain tasks, e.g. calculating CV risk [116, 120] and clinical decision-making, asthma chart review [121]

Tools designed to support management rather than diagnosis [116, 121, 122]

 No impact on duration (n = 9) [40, 48, 57, 84, 95, 103, 109, 119]

Fitting in with usual workflow ¹⁰⁰

Low usage of the study tool