Optimizing Clinical Decision Support

A recent paper in Journal of Hospital Medicine listed some practical and actionable lessons to help optimize clinical decision support (CDS). A brief summary is below: 

  • Defined metrics should be tracked over time to demonstrate progress and to make iterative improvements
  • Evaluate not only process measures but also outcome measures
  • CDS is a component of an educational program to guide and alter clinical behavior, and it must be deployed in conjunction with other educational tools
  • In teaching institutions, many orders that reflect questionable practices are entered by resident physicians, PA's, APRN's, and nurses who are least empowered to challenge requests from senior staff (therefore education is as important as CDS implementation)
  • Beware of alert fatigue. Ensure only that the necessary alerts are active
  • CDS must be maintained over time as clinical guidelines and clinician receptivity to each CDS evolves
  • Free text entered as part of structural data entry, or for overriding CDS offer significant insights on how to optimize CDS. These should be monitored systematically on an ongoing basis and used to improve CDS

CDS is a very effective tool to nudge and remind providers to practice evidence based medicine, however, it must be used judiciously to be effective.