What is Clinical Decision Support?

CDS 101 is intended to give you a broad and concise overview of Clinical Decision Support (CDS), its promise and techniques for fulfilling it, its perils and pitfalls and how to avoid them, and a variety of technical and strategic information that you can use in your own organization. This resource will provide activities that will help you design and implement CDS so that it can successfully address some of the important clinical and organizational problems in your practice. We have provided links to examples of organizations successfully using CDS to improve quality and safety, and we briefly explore some of the key factors in successful CDS, such as providing the right intervention for the right need, and avoiding "alert fatigue".

CDS 101 provides guidance on how CDS fits into an overall organizational or practice-wide plan for improved outcomes, and emphasizes the importance of strong leadership and frequent communication. We have included a downloadable C-Suite level presentation that you can customize to use at your organization to help spread the message of the importance of investing energy in designing effective CDS interventions.

Getting Started with CDS at your Organization
Promise/Peril
CDS as a Strategic Tool
Need for leadership commitment
CDS in Context: "Where it fits; where it doesn't"

Getting Started with CDS at your Organization

"So you want to do CDS" - This C-Suite level slide deck gives an overview of what CDS is, the value of CDS, challenges, leadership commitment needed and how to ensure a successful CDS program. You are welcome to download and customize this deck for use at your organization.

Promise/Peril

The promise of CDS

  • The fundamental goal of HIT is improved healthcare quality, safety and cost-efficiency for more people
  • CDS is one important tool by which these goals can be achieved. Effective, well-implemented, well-used CDS, along with measurement, feedback, and personal leadership (the computer doesn’t do this alone!) have been successful in reducing errors and adverse events, and improving compliance with quality measures in many organizations.
  • Studies have shown that CDS is particularly suitable to problems of preventive/chronic care, health maintenance, early recognition of potential hazards, adverse event prevention, appropriate resource utilization, and ensuring that results are properly handled.
  • Because of its ability to make healthcare workers aware of current data patterns, possible opportunities and hazards, and best practices for addressing them, CDS is a vital tool for promoting efficient/effective quality measurement and improvement

Perils of CDS

  • The adoption and impact of CDS have been uneven;  some clinical organizations have achieved marked reductions in adverse events, improvements in quality metrics and cost savings, while others have had poor acceptance or unintended consequences, or have avoided implementing CDS altogether for fear of both.
  • Poorly designed interventions can be distracting and disruptive, and can lead to frustrated providers as well as unintended consequences.
  • Overuse of CDS - particularly presenting too many alerts and other interventions that force the clinician to take time out from other work tasks - is one of the most common causes of CDS failure, either by causing user dissatisfaction that leads to de-implementation, or by causing providers to ignore or bypass both the excess and the important alerts.
  • In many cases, the perils of CDS result from inadequate planning and resources, and especially from inadequate communication about CDS interventions being planned and implemented.  When CDS is being designed to effect a change in practice patterns, that change must be well communicated and vetted among the healthcare team before the computer forces changes in behavior.
  • CDS itself requires continuous quality improvement. It is not something that can be implemented and forgotten.

See "CDS 101: Resources" for a sample of key 'high impact' articles.

CDS as a Strategic Tool

CDS is a very effective strategic tool for achieving an organization’s priority care delivery objectives. These objectives can be driven by external forces such as payment models and regulations related to improving care quality and safety, as well as internal needs for improving quality and patient safety, reducing medical errors, increasing efficiency and other performance enhancements.

  • CDS can be governed within the quality framework within the organization.
  • CDS is one of the tools that can be used to achieve quality goals.
  • CDS effects or results must be measured if they are to be meaningful.
  • The demonstrated value of CDS to the organization must be consistently and continually communicated at all levels and broadly across departments.
  • Successful CDS program leaders implement interventions WITH the stakeholders, rather than bringing forced change TO the stakeholders
  • CDS programs are a long-term commitment and must be designed to be for the long haul
  • Understand that there will be resistors and detractors, and be prepared to respond to their specific complaints while still fostering a positive environment.
  • Be prepared to answer any negative articles in the literature

Need for leadership commitment

  • Leadership must understand and support the efforts with energy and commitment, because:
  • CDS interventions will impact workflow throughout the organization;
  • CDS programs require ongoing investment of capital and personnel.
  • One or more clinical champions – respected and popular leaders of each major staff group that needs to ‘buy-in’ to the CDS effort - are essential. Champions serve as change agents, represent their groups in reviewing design and prioritizing projects, and communicate effectively to and from their group.

CDS in Context:  “Where it fits; where it doesn’t”

  • CDS should not be thought of as the only tool available to solve the organization’s problems. There are clear limitations to CDS interventions
    • The computer doesn’t make policy: all behavior changes that are being implemented through CDS must be thoroughly reviewed and vetted with the relevant stakeholders beforehand.
    • CDS implementation is not stand-alone; it is one method for addressing an issue, and is often best combined with other forms, including continuous monitoring, training and education.
    • There are situations where CDS is particularly effective, such as in detecting hazards and promoting best practices; and areas where CDS is less effective, particularly in areas where subtle judgment is required or where the necessary data is incomplete or imprecise.
      • The computer doesn’t make decisions: CDS is a means to support a decision and not to force it, and it must allow providers the ability to make their own judgments.