Table 2 Examples of currently deployed CDS tools and their incorporation of CDS factors
From: Beyond the threshold: real-time use of evidence in practice
CDS type | Goal of CDS | CDS specificity | CDS elements | |||
|---|---|---|---|---|---|---|
Trigger | Input data | Intervention | Offered choices | |||
Diabetes electronic management system [37] | Improve care of patients with diabetes | Generic | Diabetic patient presenting in clinic | - | Care prompts based on ADA guidelines; some tailoring based on user (nurse vs. doc vs. diabetes educator | - |
Highly tailored | - | Accepts data from institutional data systems | Printed AVS for patient; timing of next visit, tests, referrals can be indicated and printed in a document for administrative use (follow-up) | |||
Osteoporosis CDS [38] | Deliver patient-specific guideline advice to primary care physician via EHR message | Generic | Search of electronic databases for patients meeting criteria for increased osteoporosis risk | Tailored inbox message in EHR that links to patient record | Inbox message lists internal and external guideline resources that provide detailed information on osteoporosis evaluation and management | |
Highly-tailored | Demographic and diagnostic information from the EHR used to identify patients requiring management | |||||
Academic information platform for CPG Use in practice [39] | Improve guideline- recommended osteoporosis care using EHR reminders | Generic | Physician volition (i.e., no EHR-based trigger) | None | Availability of Web-based or CD-ROM based access to text of guidelines for dementia, CHF, UTI, and colorectal carcinoma | None; guidelines are read-only |
Internet-based decision support for tuberculosis therapy [40] | Improve physician knowledge of guidelines | Generic | Physician volition (i.e., no EHR-based trigger) | Physician-provided data on patient characteristics and clinical reaction to diagnostic test | Web-based implementation of hierarchical decision tree for administering preventive therapy | Guideline-based recommendations for treatment |
Clinical reminders for diabetes, coronary heart disease [41] | Improve quality of care for diabetes and heart disease using EHR reminders | Generic | - | - | - | Care recommendation; reminders were actionable but did not require acknowledgement or link to intervention |
Highly-tailored | Physician opens medical record | EHR data (lab, radiology results, problem list, medication list, allergy list) | Reminders list in the EHR in the context of other patient data | - | ||
Asthmacritic [42] | Provide patient-specific asthma treatment feedback using EHR data | Generic | - | - | - | - |
Highly-tailored | Automatic when record is open and asthma-specific data is entered | Physician-entered data on diagnosis and treatment | On-screen patient-specific comments presented to physician, tailored to current clinical situation | Physician presented with “critiquing comments” related to treatment decisions; can drill down to view guidelines to understand reason for comment | ||
Respiratory CDS [43] | Improve standardization and quality of ventilatory care | Generic | Patient “enrolled” in protocol-based care, then driven by arterial blood gas results | Order suggestions displayed to clinicians on bedside computer terminals | Clinician can document acceptance or rejection of the computer-generated suggestion | |
Highly-tailored | Arterial PO2 < 60 mmHG | Respiratory therapist charting, many other data items used (radiology results, vital signs, etc. | Clinician can order increase in FiO2 or 10%, followed by an arterial blood gas in 15 minutes | |||