This document discusses clinical decision support (CDS), which uses clinical knowledge and patient data to improve healthcare decisions. It outlines several types of CDS interventions like drug interactions checking and standardized order sets. Successful CDS requires delivering the right information to the right person in the right format through the right channel at the right time. Organizations should use CDS strategically to achieve priorities like reducing medical errors. The document provides recommendations for implementing an effective CDS program like gaining leadership support, appointing a champion, and continually communicating the program's value.

1. Where to Start and Where to Go
Don Levick, M.D., MBA
Medical Director Clinical Informatics

2.  Clinical Decision Support is a process for
improving health-related decisions and actions
with pertinent, organized clinical knowledge and
patient information.
 Information delivered can include a mixture of
general clinical knowledge and intelligently
processed patient data.
Adapted from: Improving Outcomes with Clinical Decision
Support: An Implementer’s Guide, Second Edition; HIMSS Press,
in preparation

3.  Drug-Drug Interactions  Diagnostic decision support
 Drug-Allergy interactions tools
 Dose Range Checking  Links to knowledge
references (eMedicine,
 Standardized evidence
National Comprehensive
based ordersets
Cancer Network )
 Rules to meet strategic
 Links to local policies
objectives (core
measures, antibiotic  Point of care reference
usage, blood information (i.e.
management) InfoButtons)
 Documentation templates  Web based reference
information
 Relevant data displays

4.  Successfully applying CDS to improve a targeted
objective requires that the
◦ right information be delivered to the
◦ right person in the
◦ right intervention format through the
◦ right channel at the
◦ right point in workflow.

5. • CDS should be used as a strategic tool for
achieving an organization’s priority care delivery
objectives.
• These objectives are driven by:
 Internal needs (PI/QI, Med error reduction)
 External forces (Meaningful Use, P4P, TJC)

6.  “Implement one clinical decision support rule relevant to
specialty or high clinical priority along with the ability to track
compliance to that rule.”
◦ Must use patient-specific information to offer diagnostic or
treatment options to the provider within its logic.
◦ It must be conditional: the rule will produce a different
action or different information, based on the patient-
specific information.
 http://www.himss.org/content/files/CDS_MU_FAQ.pdf

7. • CDS interventions will impact workflow throughout
the organization; therefore leadership at all levels
must understand and support the efforts
• A high level understanding of a CDS program
should include an understanding of the “Five Rights
of CDS”
• CDS programs require ongoing investment of
capital and personnel
• A champion is required to be a change agent and
lead the charge

8. • CDS should not be thought of as the only tool
available to solve the organization’s problems.
• There are clear limitations to CDS interventions

9. • The value of the CDS program to the organization must be
consistently and continually communicated at all levels
• Successful CDS programs implement interventions WITH the
stakeholders, and not TO the stakeholders
• Be aware of the continuum of intrusion
• Impact on workflow and screen response time
• Close monitoring of all CDS must occur regularly to ensure
validity.
• “If it can’t be measured, it can’t be managed”
• Be prepared to deal with resistors and detractors, including the
ability to answer to negative articles in the literature

10. Contact information:
donlevick@ptd.net