Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup

In functional terms, clinical decision support (CDS) is defined as: “providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered and presented at appropriate times, to enhance patient care.” This includes reactive alerts and reminders as well as other intervention types such as medication reference information for prescribers and patients, patient- specific dose checking etc. Some of the healthcare objectives that can be addressed with CDS are; reduced medication errors and adverse medical events, cost-effective and appropriate prescription medication use, and compliance with accreditation and regulatory requirements.

CDS in eRx can improve the safety, quality and efficiency of care. To realize the full impact of CDS on health care, new mechanisms to provide access to current knowledge, accelerated implementation of standards and coding systems, and appropriate incentives for use are all required. While benefits can be obtained from standalone eRx systems, progression to a more comprehensive electronic health record is necessary to reap the full spectrum of benefits.

This consensus white paper sets forth recommendations and action plans in three critical domains: (1) database elements; (2) uniform standards, vocabularies and centralized knowledge structures; and (3) appropriate financial and legal incentives to promote adoption. It provides an overview of the current state of CDS-enabled eRx, describes barriers of adoption and provides probable solutions to these barriers. Some of the recommendations address:

• Features and elements needed for eRx systems to provide effective, high-value CDS with target implementation dates.
• A listing of components that should be available in basic and advanced CDS systems for eRx in 2006 ad 2008.
• Standards and vocabularies that must be developed at a national level in order to efficiently support dissemination and sharing of CDS interventions and also to adopt the research findings into practice.
• Incentives and structures that could be developed at a national level in order to efficiently support dissemination and sharing of CDS interventions.