So you’re telling me now that we have an EHR we need a CDS too? Wtf is a CDS?
What is Clinical Decision Support (CDS)?
CDS Roadmap Definition of CDS: Clinical decision support (CDS) is an expert system that provides “clinicians, patients, or individuals with knowledge and person-specific or population information, intelligently filtered or present at appropriate times, to foster better health processes, better individual patient care, and better population health.”
ELI5 Definition of CDS: Intelligent software typically built over an EHR to help clinicians make better decisions.
Often times, CDS is often referred to as a Clinical Decision Support System (CDSS). Just FYI.
Typical Features of CDS
Here’s a list from DHHS on some features you’re likely to find when working with a CDS.
- Computerized alerts and reminders to care providers and patients
- Methods to bring care into compliance with clinical guidelines/protocols
- Condition and treatment-focused order sets
- Patient data reports and summaries
- Documentation templates
- Advice to promote more accurate and timely diagnoses
- Contextually relevant reference information
Quick example:
Little Jimmy comes in to your pediatrics office because of an ear infection. You pull up his record on your EHR and Pop! Theres an alert that says he hasn’t gotten his flu shot this season. Killing two birds with one stone…oh yeahhh, CDS.
Benefits of CDSS
CDS can eliminate many common human errors.
Have a patient on Zocor but you’re about to prescribe them Cordarone? A red flag or alert will let you know that that may not be the best decision. And while trying to maintain your sanity and lucidity at the end of a long call, that annoying little pop-up can save lives.
In addition, Clinical Decision Support Systems offer:
- Administrative Benefits by supporting clinical coding and documentation, authorization of procedures, and referrals.
- The ability to manage clinical complexity and details by keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care.
- Cost control benefits through the monitoring of medication orders and avoiding duplicate or unnecessary tests.
- Decision support benefits: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific guidelines, and population-based management. [Perreault & Metzger, 1999]
Potential Difficulties in Dealing with a CDSS
CDS is not an excuse to become lazy or let the system do all the hard work. It also does not work in all situations. To be most effective it should be integrated with your clinical workflows.
Have all of your workflows documented? Great! It will be a bit easier to implement. No workflows documented? You may not get as big of a value out of it at first.
If your hospital has noticed some troubling trends, finding where in the workflow the problem is occurring and then configuring the system to spit out proper alerts or offer insight on how to properly complete the step that has been going wrong could move the trend in a more positive direction.
Configuring the system to avoid annoying the clinicians with too many unneeded alerts that break their concentration is also something to think about when implementing a CDS. No one wants to go into a patient’s EHR and have the same number of pop-ups experienced from a bad 90’s geocities website. Yuck.
List of Clinical Decision Support Systems
- SimulConsult
- Clinical Rules
- DiagnosisPro
- DxMate
- Dxplain
- ESAGIL
- MYCIN
- Prescriptor
- RODIA
- ISABEL
That’s our short ELI5 summary of clinical decision support and clinical decision support systems. Overall, we covered what a CDS/CDSS is, what they do, benefits of implementation, and some considerations to take when implementing such a system. We hope that you leave this post with a bit more knowledge about CDS than you came with.
If you’re interested, check out some of the other posts in the “explain it like I’m 5” series or share on your social channels to help us grow and produce more great content.
Cheers!
Good to Know Terms
Expert system– a computer system that emulates the decision-making ability of a human expert. Expert systems are designed to solve complex problems by reasoning about knowledge, represented primarily as if-then-else rules rather than through conventional procedural code
Resources and References:
Perreault L, Metzger J. A pragmatic framework for understanding clinical decision support. Journal of Healthcare Information Management. 1999;13(2):5-21.