In last week’s clinical informatics practice question, we discussed sensitivity and specificity. This week we’ll be sticking with the clinical decision making and care process improvement theme but move on to how we can improve healthcare outcomes within Clinical Decision Support Systems (CDSS) using the five rights of CDS.
Where Does this Fit Within the Core Content?
The five rights of CDS is a principle that applies to many topics under the “application of clinical decision support”. Because of this, we’ve highlighted that these five rights can apply to the types of CDS, users of CDS, and the implementation of CDS.
2. Clinical Decision Making and Care Process Improvement
2.1.1. The nature and cognitive aspects of human decision making
2.1.2. Decision science
2.1.3. Application of clinical decision support
184.108.40.206 Types of decision support
220.127.116.11 Users of decision support
18.104.22.168 Implementing, evaluating, and maintaining decision support tools
2.1.4. Transformation of knowledge into clinical decision support tools
2.1.5. Legal, ethical, and regulatory issues
2.1.6. Quality and safety issues
2.1.7. Supporting decisions for populations of patients
A Quick Bit About CDS
The five rights of CDS were first outlined in “Improving medication use and outcome with CDS: a step-by-step guide” edited by Jerome A. Osheroff, MD. The five rights describe five ways CDS systems can rightly intervene to improve targeted healthcare outcomes and decisions.
Of course we’re not going to just give you the five rights straight away. That’s what the question is for! So let’s get into it.
Which of the following is NOT one of the five rights of CDS?
A. The right intended audience
B. The right place in the software
C. The right channel
D. The right information
Answer and Explanation
The five rights of CDS are:
- The right information
- Is the information evidence based? Suitable to guide action?
- The right person
- Who is the person that needs the information the most? A nurse, patient, clinical, administrator, or a patient’s caretaker?
- The right intervention format
- Is an alert best? Or would a popup, information reference, or order set work better?
- The right channel
- Which clinical information system the best place to present this intervention? Or would a mobile or web format work better?
- The right time in the workflow
- When is the best time to present this intervention? During the decision process? When an action needs to be taken?
If you forget the specifics of the five rights, just ask yourself, what is the right “who, what, where, when, and why/how” of a CDS intervention. Who is the right person? What information does that person need? Where is that information most useful (EHR, LIS, CPOE, etc.)? When in the workflow in that information needed? How is the best way to get them that information (alert, popup, order set, etc.)?
The right place in the software is not one of the five rights of CDS. A good CDSS may be essentially invisible to the provider or patient until it’s necessary, integrated completely with the EHR and other clinical information systems. Therefore putting an intervention in the right spot in the software does not make much sense, if the software doesn’t have much of a direct user interface.
Therefore, the correct answer is B. The right place in the software.
Recommended Reading and Links
The five rights of clinical decision support: CDS tools helpful for meeting meaningful use. Robert Campbell, EdD, CPHIMS, CPEHR.
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