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What Is Clinical Decision Support?

Many clinicians are still unclear what clinical decision support (CDS) means. Eligible Professionals (EPs) in medical practices who have attested, or are in the process of attesting, to the Medicare and Medicaid EHR Incentive Programs should already know that they must meet the Stage 1 menu criteria related to CDS. That means they must implement one clinical decision support rule, and be able to track compliance. This is necessary to demonstrate Meaningful Use of certified EHR technology,

For example, I am often asked if e-prescribing is considered as clinical decision support. The short answer to the question is “no.”

According to a recent study (April 23, 2012) conducted by the Agency for Research Health and Quality, the authors  concluded, “Both commercially and locally developed Clinical Decision Support Systems (CDSSs) are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse.”

That is helpful, but it’s still unclear what really makes up CDS.


According to HIMSS, “Clinical Decision Support” is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.

Information recipients can include:

  • Patients,
  • Clinicians, and
  • Others involved in patient care delivery.

Information delivered can include:

  • General clinical knowledge and guidance,
  • Intelligently processed patient data, or
  • A mixture of both.

Information delivery formats can be drawn from a rich palette of options that includes:

  • Data and order entry facilitators,
  • Filtered data displays,
  • Reference information, alerts and others.


HIMSS provides the following example of CDS in its CDS Scenarios 101 site for a primary care physician’s office: You are a primary care physician in a large group practice that uses an electronic health record. At the beginning of each visit, you view a dashboard of preventive care measures — like flu vaccine, colon cancer screening, cholesterol tests — that are due for your patient, based on age, medical history (problem list), and medication list stored in the EHR.

If you’d like to learn more, the HIMSS website has built some valuable resources for clinicians and the industry with case studies and an updated book on CDS.

The second edition of this authoritative best-seller, Improving Outcomes with Clinical Decision Support: An Implementer’s Guide, has been substantially enhanced with expanded and updated guidance on using CDS interventions to improve care delivery and outcomes in diverse care settings. The book is available at the HIMSS online store.

The new edition is more reader-friendly than the earlier version with sections that help:

  1. Set up (or refine) a successful CDS program in a hospital, health system, or physician practice; and
  2. Configure and launch specific CDS interventions that recipients appreciate and  measurably improve targeted outcomes.

Two detailed case studies illustrate key points showing how a “real-life” CDS program — and specific CDS interventions — might evolve in a hypothetical community hospital and small physician practice.

I like the book because it provides readers with enhanced worksheets — including sample data — that help readers document and use information needed for their CDS program and interventions. Sections in each chapter present considerations for health IT software suppliers to effectively support their clients implementing CDS.

HIMSS resources provide eligible professionals with actual examples to help them not only meet the Stage 1 Meaningful Use criteria, but also to build the needed evidence for improved clinical, economic, workload, and efficiency outcomes.

Now, back to my original question — and answer — on defining clinical decision support. I hope you will agree with me that, if done correctly, CDS can help providers deliver safe and efficient care for patients.

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