The FIVE "RIGHTS" of CLINICAL DECISION SUPPORT

Headnote

CDS TOOLS HELPFUL FOR MEETING MEANINGFUL USE

A 75-YEAR-OLD MAN sits uncomfortably on an examination table as his physician informs him that he needs to get a colonoscopy. The patient, an ex-cop, barks at the physician, "Why after all these years do I need to get a colonoscopy?" The physician coolly responds, "With a paper record, I never realized that you had a family history of colon cancer, and now that your health information is being recorded in an electronic health record (EHR) system, I am being alerted that it is time for you to have a colonoscopy." The man relents and has the procedure. A small walnut-shaped tumor is discovered in his colon, which turns out to be cancerous. The man undergoes successful chemotherapy treatment and has just celebrated another birthday. This is a best case scenario of what can happen in a world with clinical decision support.

With the advent of the "meaningful use" EHR Incentive Program, healthcare organizations, along with healthcare providers, are required to integrate clinical decision support (CDS) into their federally certified EHR systems. To provide a foundation for understanding how to develop a systematic CDS program, one should note the five "rights" of clinical decision support. In framing the discussion, CDS will be defined in terms of its relationship to meaningful use, with the most common forms outlined, and evidence provided showing where CDS has been most effective in improving quality of care.

Clinical Support Meets Meaningful Use

CDS has been defined as a "process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve healthcare and healthcare delivery."1 To understand the relationship between CDS and meaningful use, it is important to comprehend, in an unconventional way, why the concept of meaningful use has come into existence. Few, if any, remember the era when the concept of standardized time zones did not exist. In that era, a person could start a journey in one town at 8 a.m. and arrive in a town two miles away at 7:50 a.m., and arrive in another four miles away at 7:55 a.m. Time was relative to location. With the creation of the concept of a time zone, time became more absolute.

Fast forward to the...