Clinical Decision Support (CDS) provides timely information to help inform decisions about a patient's care and has the ability to significantly impact improvements in quality, safety, efficiency, and effectiveness of health care. The Centers for Medicare & Medicaid Services (CMS) defines CDS as "health IT functionality that provides persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.” CDS encompasses a variety of tools and processes to enhance decision-making in the clinical workflow. CDS is not simply an alert, notification, or explicit care suggestion. CDS helps clinical teams by supporting some routine tasks, warning of potential problems, or providing suggestions for the clinical team and patient to consider. CDS encompasses, but is not limited to
- Computerized alerts and reminders for providers and patients
- Condition-specific order sets
- Focused patient data reports and summaries
- Documentation templates
- Diagnostic support
- Contextually relevant reference information
CDS is not intended to replace clinician judgment, but rather to assist care team members in making timely, informed, and higher quality, evidence-based decisions, incorporating resources like clinical guidelines and best practices. The CDS Five Rights model states improvements are achieved in desired healthcare outcomes if communicating
- The right information
- To the right people
- In the right CDS intervention formats
- Through the right channels
- At the right times in workflow
CDS and eCQMs are closely related, share many common requirements, data elements, and support health care quality improvement. The impact of a CDS intervention may be assessed with an eCQM.
Learn about Key Federal CDS Efforts
Agency for Healthcare Research and Quality's (AHRQ) Patient-Centered Outcomes Research (PCOR) CDS Initiative aims to advance evidence into practice through CDS and make CDS more shareable, health information technology standards-based, and publicly-available. The initiative’s main components are
- CDS Connect features a prototype infrastructure for sharing interoperable CDS and includes a web-based repository of CDS artifacts, a CDS Authoring Tool that utilizes clinical quality language, other open-source software, and lessons learned from use case demonstrations.
- CDS Innovation Collaborative (CDSiC) - is a learning collaborative with a focus on patient-centered CDS. In contrast to traditional clinician-facing CDS, patient-centered CDS is CDS that focuses on the patient, or their caregiver, and facilitates their active involvement in health care decision-making with their clinicians. The CDSiC brings together diverse perspectives to advance the field of patient-centered clinical decision support, making it more valuable and meaningful to patients, clinicians, and healthcare systems.
- Through it's multiple workgroups in the Stakeholder Center and various patient-centered CDS projects in the Innovation Center, the CDSiC has developed many resources that can be used in developing and implementing patient-centered CDS.
- Funding opportunities targeted to Digital Healthcare Research and clinical decision support efforts.
- CEDAR: The CEPI Evidence And Discovery (CEDAR) project aimed to make evidence repositories, such as those developed by AHRQ’s Center for Evidence and Practice Improvement (CEPI) more FAIR - findable, accessible, interoperable, and reusable - through technologies such as application programming interfaces. Though future development of CEDAR ended in September 2023, the source code will continue to be available and health information technology developers, including eCQM and CDS developers, can incorporate the evidence and design new and exciting ways to make the information available where, when, and how stakeholders need it most.
- An evaluation project that combines an evaluation of AHRQ’s CDS initiative with a horizon scan of the future of patient-centered CDS.
The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) also defines clinical decision support and recently introduced the term ‘decision support interventions’ with their updated EHR Certification Rule criteria under §170.315(b)(11).
The U.S. Food and Drug Administration (FDA) in their Digital Health Center of Excellence (DHCoE) provides information on device and non-device CDS in their final guidance document Clinical Decision Support Software.
Appropriate Use Criteria Program was a CMS program to promote the adoption of appropriate use criteria for advanced diagnostic imaging services through CDS. Appropriate use criteria are evidence-based and assist professionals who order and furnish applicable imaging services to make the most appropriate treatment decisions for a specific clinical condition.
Optimizing Strategies for Clinical Decision Support - The National Academy of Medicine and the Office of the National Coordinator for Health Information Technology special publication summarizes a meeting series with multi-stakeholder experts who discussed the potential of CDS to transform care.
Adapting Clinical Guidelines for the Digital Age - American Journal of Medical Quality featured supplement including:
- Commentary: Modernizing Guidelines Development to Speed the Transfer of Science to Patient Care
- Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach
- An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines
- An Evaluation Framework for a Novel Process to Codevelop Written and Computable Guidelines
- Adapted Kaizen: Multi-Organizational Complex Process Redesign for Adapting Clinical Guidelines for the Digital Age
The standards used for the electronic representation of CDS and eCQMs were developed separately and used different data models and computable expression languages. CMS and the Office of the National Coordinator for Health Information Technology (ONC) supported efforts to identify, develop, and harmonize standards. Clinical Quality Language (CQL) is a logic expression language that can be used with both CDS and eCQMs. Beginning in 2019, CQL is used in eCQMs for CMS quality reporting/performance periods. Learn more about efforts to harmonize standards for CDS and eCQM.
Current standards
- Clinical Quality Language (CQL)
- Fast Healthcare Interoperability Resources (FHIR®) Clinical Reasoning Module and key components
- FHIR® Quality Improvement Core (QI Core)
- Implementation Guide for using FHIR® to develop eCQMs and CDS
- FHIR Clinical Guidelines “CPG-on-FHIR”
- CDS Hooks
- Context-Aware Knowledge Retrieval (Infobutton)
- Composite Knowledge Artifact Conceptual Model (KNART)
- CDS Knowledge Artifact Specification (KAS)
Visit the HL7® CDS Workgroup
- Visit the HL7® CDS Workgroup
- Use CDS Connect, a collaborative model for CDS development
- Learn more about and engage with the CDS Innovation Collaborative on patient-centered CDS