Clinical Decision Support
Clinical decision support (CDS) is a digital tool that provides timely and person-specific information, intelligently filtered or presented at appropriate times, to enhance patient outcomes and quality of care.
Clinicians use CDS at the point of care, but it can be used in other settings to drive care quality, safety, efficiency, and effectiveness. This includes patient-centered CDS, which helps to boost patient engagement by getting patients or caregivers involved with their clinician and active in the decision-making process.
How CDS Tools Support Care Decisions
Clinical decision support (CDS) uses different tools to help providers, patients, and the care team make better care decisions. The information must be clear, well-organized, and fit into the provider’s workflow so they can act quickly and confidently. Different types of CDS work best for different kinds of care and settings.
These tools can include:
- Order sets tailored to specific conditions
- Patient data summaries and reports
- Documentation templates
- Diagnostic support
- Reference materials relevant to the situation
- Clinical guidelines
- Computer alerts and reminders for providers and patients
To work well, CDS needs:
- Medical knowledge that can be used by computers
- Information specific to the individual patient
- A system that combines this knowledge and data to give useful information in real time
CDS applications operate as components of comprehensive EHR systems or as stand-alone CDS systems or plug-ins to EHRs.
Improved Care Through Data Sharing
ONC supports efforts to develop, adopt, implement, and evaluate the use of CDS to improve healthcare decision-making.
We aim to help the healthcare industry create the technical infrastructure needed to allow health systems to share data with each other electronically to provide the most complete information possible into CDS systems. Complete records allow CDS systems to help with diagnoses and track for negative drug interactions by having a better view of a patient’s whole health.
Thoughtfully implemented CDS can have a number of important benefits, including:
- Increased quality of care and enhanced health outcomes
- Reduced errors and adverse events
- Improved efficiency, cost-benefit, and provider and patient satisfaction
When implemented properly, CDS can reduce errors, improve the quality of care, reduce cost, and ease the cognitive and administrative burden on providers. CDS provides a platform for integrating evidence-based knowledge into care delivery by drawing upon both patient-specific data and research findings. By providing users with timely and meaningful data, CDS can help to avoid redundant testing or even identify alternative care approaches with better patient outcomes.
Optimizing Strategies for CDS
ONC collaborated with the National Academy of Medicine (NAM) to engage key experts and develop a series of strategies and recommendations to optimize CDS in support of improved care. The project’s goals were to identify actionable opportunities to accelerate progress in CDS creation, distribution, and use; inspire action on priority opportunities amongst diverse stakeholder groups; and to drive progress towards a usable, interoperable CDS. While some technologies have evolved since this report was published in 2016, most of the policy, workflow, and process considerations remain relevant and useful.
Additional CDS Resources
The CDS Hooks Sandbox was designed to promote awareness of CDS capabilities and facilitate the testing of CDS Hooks services. Sandboxes are isolated test environments that allow users to experiment with a system or service without impacting other systems or data.
CDS Hooks Sandbox ResourcesThe Centers for Disease Control and Prevention (CDC) released the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain to help clinicians and patients work together to make informed, patient-centered decisions about pain care. CDC and ONC work collaboratively to convert CDC recommendations into shareable electronic CDS tools for electronic health records.
Electronic CDS Tools Supporting Opioid PrescriptionSince 2015, CDC and ONC have worked collaboratively to convert opioid clinical practice guidelines into standardized and shareable CDS interventions to be used in and by electronic health records to support appropriate prescribing. The purpose of this project is to expand the capacity for the application to support shared clinician-patient decision making and scale the implementation tool in resource-constrained clinical sites.
Scaling and Dissemination of Open-Source Electronic CDS ToolThe Data Exchange Profiles for 2022 CDC Clinical Practice Guideline for Prescribing Opioids defines exchange expectations for systems that implement the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain, both in terms of the data required to evaluate whether recommendations are applicable, as well as the data required to represent proposals resulting from those recommendations.
Data Exchange Profiles for 2022 CDC Clinical Practice Guideline for Prescribing OpioidsThe 2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation Guide provides resources and discussion in support of applying the Centers for Disease Control and Prevention (CDC) 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain.
2022 CDC Clinical Practice Guideline for Prescribing Opioids Implementation GuideThe Da Vinci – Coverage Requirements Discovery standard aims to streamline insurance coverage determinations for healthcare services in the United States. The standard introduces a new approach using FHIR and CDS Hooks technologies to enable real-time, context-specific coverage discovery within a provider’s EHR system. It addresses limitations of traditional insurance adjudication processes by operating on clinical orders and providing rapid responses.
Da Vinci – Coverage Requirements DiscoveryCreating Value by Modernizing and Measuring CDS
This 2023 Tech Forum session discussed how CDS may be valuable, including the proposed requirements for certified health IT and predictive decision support interventions, how new technologies can add value to CDS, and how the impact of CDS can be measured and evaluated.
Watch RecordingThe Future of CDS (Sept 2023)
The 2023 Tech Forum session: The Future of CDS covered topics important to the future of clinical decision support. The session began with education sessions on CDS Hooks, SMART apps, and CDS Connect. Speakers discussed patient-centered CDS, focusing on the work of AHRQ’s Clinical Decision Support Innovation Collaborative. The session closed with a discussion on ways to incorporate CDS into new topic areas such as social determinants of health, cancer screening, and other areas.
Watch RecordingWhat to Know About CDS Through Real World Examples
This 2023 Tech Forum session included speakers from ONC and healthcare partners who spoke about the real-world benefits, challenges, and limitations, as well as trends.
Watch Recording