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To assess the frequency, fidelity, and impact of replication studies in the clinical decision support system (CDSS) literature.

A PRISMA-compliant review identified CDSS replications across 28 health and biomedical informatics journals. Included articles were assessed for fidelity to the original study using 5 categories: Identical, Substitutable, In-class, Augmented, and Out-of-class; and 7 IMPISCO domains: Investigators (I), Method (M), Population (P), Intervention (I), Setting (S), Comparator (C), and Outcome (O). A fidelity score and heat map were generated using the ratings.

From 4063 publications matching search criteria for CDSS research, only 12/4063 (0.3%) were ultimately identified as replications. Six articles replicated but could not reproduce the results of the Han et al (2005) CPOE study showing mortality …