CONCLUSIONS
Conducting, randomized, multi-site, CDS interventions using different EHRs with different clinical workflows, upgrade cycles, patient populations, CDS governance committees, and different abilities to configure local CDS features is challenging. An EHR-embedded CDS intervention was effective at improving problem list completeness but was not associated with improvements in quality measures. The problem inference algorithms developed may have additional uses, such as improving the accuracy of clinical quality measures or EHR-based phenotyping locally or in networks such as eMERGE.